Industrialization/corporatization of pharmacy - I assume it is the same all over the US. When one walks into one of these chain pharmacies one sees an exasperated staff answering calls, taking orders from the drive thru, filling prescriptions, catering to lines of customers, calling doctors, insurers, kept on hold, etc. I feel sorry for them. (In contrast has anyone ever seen a government agency employee work so hard?) I read this and I can relate:

It was the Tuesday after Memorial Day and my fourth consecutive 13-hour day in the pharmacy. Having just passed the boards, I landed a job as a floating staff pharmacist. It was my first time working at this store and my third store in as many days. I did not know what to expect except that, as usual, I would be the only licensed pharmacist working here today. This fact struck me as a microcosm of my profession's ineffectualness—an ineffectualness resulting from misaligned objectives and poor processes of care, afflicting first pharmacists and, ultimately, patient care.

Today's store was small and old, the mirror against the wall a vestige of the soda fountain of years past. The fibrous carpet, with its familiar gray-square pattern, was the same as that at the two megastores where I worked over the weekend. Familiar, too, was the impending tumult of the day, which was as disruptive to the 20-year veteran pharmacist who managed this store as it was to me.

Arriving at the pharmacy, I entered the alarm code and raised the dusty gate. I prepared the cash register and logged into the ancient computer system, wondering when the pharmacy technician was due to arrive. Fifty new refill requests awaited. I preferred to arrive early for busy shifts, especially on a Tuesday after a holiday, but it was against corporate policy.

I answered the telephone. “Jim, this is Rocco. I need my orange pills and my inhaler,” the caller said.

“Sir, Jim has the day off. I'm filling in for him. Let me see whether I can help you. What is your last name?”

He hung up. I answered a second call. It was the practice nurse from one of the local primary care providers responding to a question left on voicemail the previous evening. Prescriptions with pending problems are conventionally left in plain sight, but I found no note or other evidence of the situation. Perhaps the permanent pharmacists would have known of this issue, though not through any evident record-keeping system. No two systems were alike.

“I'm sorry, but I'l have to call you back,” I said.

She hung up, wasting no time on pleasantries. My anxiety grew.

Standing alone in the pharmacy, I turned my attention to the now 60 prescriptions waiting. I spent the next 10 minutes processing the prescription orders, overriding the many warnings that popped up on the computer screen, thinking of the alarm fatigue that my colleagues at the hospital experience with medical equipment. The whirling of the laser printer drowned out the overhead music.

The first technician arrived 15 minutes late and began counting tablets on a small plastic tray by using a spatula that resembled a butter knife. Meanwhile, I was caught in a proxy battle with an insurance company. They no longer paid for olmesartan. A patient would have to use an alternative drug that her insurance company now preferred.

I called the physician's office to request a substitution, cursing the fact that I could not make the substitution without a physician's approval. After waiting on hold for several minutes, I left a message requesting a prescription for valsartan. I made a note to call the customer, who had not yet learned that her prescription was changing.

The technician was also on the telephone, and four customers arrived at the counter in rapid succession. The first woman tapped her keys on the counter, apparently to ensure that we noticed her. I smiled at her while my anxiety mounted.

After hanging up the telephone, I greeted the woman at the counter. She handed me a prescription for isotretinoin, for which the Food and Drug Administration required a special program for therapeutic risk management. I had to call a telephone-based registry system before filling the prescription.

“I have a new insurance card,” she said, handing me a card that had no information that could be used for billing a pharmacy claim.

“You should have received a separate card for your pharmacy coverage,” I told her. “Do you have it?”

“I didn't get it.”

“I'l call the insurance company,” I said.

“How long will it take?”

“About 30 minutes.”

“But your advertisement says that prescriptions will be filled in 15 minutes or less.”

She was right.

“I'm sorry, but that is not feasible at the moment. I'l finish it as soon as possible,” I said.

She walked away with an angry look. I didn't notice, but that day I had not yet used any knowledge of pharmacotherapy that was the focus of my training.

The next customer was an overweight, out-of-breath woman in her mid-70s named Mrs. da Silva, who arrived with her daughter. Mrs. da Silva was a regular customer who spoke only Portuguese. Translating, the technician told me that Mrs. da Silva was just discharged from the hospital for what I inferred was an acute myocardial infarction. I had no access to her actual diagnosis or medical records. Mrs. Da Silva handed me 12 prescriptions written by the hospital's housestaff.

In subsequent moments, I prioritized the filling of Mrs. da Silva's prescriptions; her pale appearance suggested that she would be better off resting at home than sitting on a bench next to the pharmacy. The chaos of the routine prescription-filling circled just beyond my attention.

As the technician translated, I began counseling Mrs. da Silva on the importance and logistics of taking the medicines. I realized quickly that she learned very little about the medications from her doctors at the hospital, which came as no surprise. During the inpatient rotations of my training, I learned how hectic hospital life could be for medical interns and residents.

Then, a second technician whose arrival I barely noticed interrupted to tell me that I had to take an urgent telephone call from a cursing customer. The caller was a man irate about the copayment for the prescription that his daughter had just picked up. When I returned to the counter, Mrs. da Silva was gone. I contemplated calling her when she arrived home but was interrupted by a beeping noise indicating that a car was at the drive-through pharmacy window.

“She just wanted to go home,” said the technician who had translated.

I do not know why I allowed my conversation with Mrs. da Silva to be interrupted except that a typical day at a corporate pharmacy involves being understaffed and overworked, resulting in the need to address one urgency after another. Technician help is scarce, not because there are too few technicians but because corporate overseers allocate staffing resources.

Moreover, prompt responses are expected in retail, even if I have no influence over the physician's choice of drug or the insurance company's coverage policies. The large corporate pharmacies limit staff in favor of profit and promise convenience instead of health care. I also know that continuity of care after discharge from the hospital is imperfect and that community pharmacists are the most accessible health care providers.

As a community pharmacist, I cannot be expected to be a patient's primary care provider; indeed, physicians must follow their sickest patients closely. However, it seems that improving the patient-centeredness rather than profit-centeredness of pharmacy care would prevent lost opportunities for patient–provider dialogue, such as that with Mrs. da Silva.

Reflecting on the reasons why I went to pharmacy school, I recall that in my precollege years I had simply wanted a future career where I could help people. Although I considered a range of options, the college of pharmacy's recruitment materials touted the effect that one could have after completing the required doctoral-level training. Perhaps in a different practice setting that effect could be realized.

I spent the remainder of the day filling the 400 prescriptions that were waiting for my attention, talking to customers and physicians’ offices on the telephone, and answering routine questions at the counter, all the time being rushed by the incessant flow of work. Yet, when I walked away from Mrs. da Silva, I knew that I had missed the most important opportunity that day to provide real pharmaceutical care.

Several months later, I was back at the same pharmacy working with the same technicians when Mrs. da Silva's daughter came in to tell us that her mother had died. With sad eyes, she told us that it was unexpected, because Mrs. da Silva had made a promising recovery from the first heart attack.

When I opened her pharmacy record to document that she was deceased, I noticed that Mrs. da Silva had never refilled her 12 prescriptions. My heart sank. To this day, I wonder whether Mrs. da Silva died of a diseased heart or a broken pharmacy system.****

It's a simple enough request, but for patients and families who feel vulnerable, scared or uncomfortable in a hospital room, the subject can be too intimidating to even bring up with a doctor or nurse: Have you washed your hands?

Hospitals are encouraging patients to be more assertive, amid growing concern about infections that are resistant to antibiotics.

Strict hand hygiene measures are the gold standard for reducing infections associated with health care. Acquired primarily in hospitals but also in nursing homes, outpatient surgery centers and even doctor's offices, they affect more than one million patients and are linked to nearly 100,000 deaths a year, according to the Centers for Disease Control and Prevention.

The CDC aims to engage both patients and caregivers in preventing dangerous hospital infections.

Yet despite years of efforts to educate both clinicians and patients, studies show hospital staff on average comply with hand-washing protocols, including cleansing with soap and water or alcohol-based gels, only about 50% of the time. Two new studies show patients aren't much more comfortable today than a decade ago with the idea of asking doctors and medical staff to lather up.

Hospitals have reduced certain infections over the past four years with measures such as removing unnecessary catheters and washing a patient's skin before surgery with antibacterial soap. Some have lifted hygiene compliance to nearly 100% with strict "wash in, wash out" protocols, and some have designated unidentified staffers to secretly monitor co-workers. Some hospitals link merit increases to compliance and temporarily suspend clinical privileges of doctors who ignore the rules, says Gina Pugliese, vice president of the Safety Institute at hospital purchasing alliance Premier Inc. According to a 2010 study, a disciplinary program at the University of Kentucky Medical Center in Lexington that included suspending doctors' privileges led to improved compliance rates.

More hospitals have turned to electronic sensors, thermal imaging and video cameras to monitor hand hygiene, and some are issuing badges that wirelessly record staffers' use of hand hygiene stations before entering a patient room. Some monitoring systems emphasize patient engagement and sound an electronic alert to remind patients to speak up when a staffer enters the room.

The CDC has provided 16,000 copies of a video, titled "Hand Hygiene Saves Lives," to be shown to patients at admission. In one scenario, a doctor comes into a room and the patient's wife says, "Doctor, I'm embarrassed to even ask you this, but would you mind cleansing your hands before you begin?" The doctor replies, "Oh, I washed them right before I came in the room." The wife says, "If you wouldn't mind, I'd like you to do it again, in front of me."

After patients at 17 hospitals run by Cincinnati-based Catholic Health Partners watched the video, there was a rise in both the proportion of patients asking staffers to wash their hands, and physicians and nurses reporting that they were asked, according to a 2010 study. "Hand hygiene is probably the most important thing health-care workers can do to protect their patients from infection," says John Jernigan, director of the CDC's hospital infection-prevention efforts who appears in the video. When patients speak up, it helps create "a culture of safety," he says.

The nonprofit Association for Professionals in Infection Control and Epidemiology is kicking off a campaign this month including posters mailed to 15,000 hospitals with tips on how patients can take an active role. It suggests asking staff about hand hygiene and requesting that hospital rooms be cleaned if they appear dirty.

"We've been focusing on intensive interventions to improve hand hygiene among health-care workers for decades, yet we've really shown very little progress," says Carol McLay, a Lexington, Ky., infection prevention consultant and chair of the committee that designed the campaign. "We are trying to empower patients and families to speak up and understand their role."

At some hospitals, posters, bedside placards and buttons for staffers say, "Ask me if I've washed my hands." Susan Coffin, a pediatric infectious disease physician at the Children's Hospital of Philadelphia, says while many efforts are made in good faith, they are "insufficient to overcome some of these barriers." She is co-author of a study, published in June in the American Journal of Infection Control, which found that 84% of parents were aware of infection risk yet only 67% would remind a health-care worker to wash their hands, most often because of concern about appearing rude or undermining authority. Yet 92% of parents said if a health-care worker invited reminders, they would be more likely to do so. The hospital is "trying to make it a more active conversation," Dr. Coffin says. Admission packets offer detailed information on hand hygiene and nurses tell families that staffers welcome questions about hand washing.

In a study published in September in the journal Infection Control and Hospital Epidemiology, one-third of patients surveyed at the University of Pittsburgh Medical Center said they observed doctors failing to wash their hands, but nearly two-thirds said nothing to their doctor about hand hygiene. Most didn't believe it was their role to do so and said they felt embarrassed or awkward and worried about reprisal.

Patients are more likely to ask nurses about hand hygiene, says Gregory Bump, associate professor of medicine. "There is something about the white-coat barrier that makes them reluctant to challenge doctors." Physicians may resist assertive patients and seem unreceptive or even hostile to a question about hand washing, he says.

Patients, instead of receiving information about infections and hand washing, would prefer having staffers wear a button or light to indicate whether his or her hands had been washed, the study also found. UPMC is developing a system to measure and track hand-washing compliance, as well as computerized verbal reminders to patients to ask the employee to clean their hands when they enter the room.

Michael Gettes, 50, has been hospitalized several times and says he has never had to remind Dr. Bump, his primary physician, to wash his hands. He has asked other hospital staffers to do so. One doctor reacted negatively. "It put our relationship on a bad footing," Mr. Gettes says. "Yes, you run the risk of upsetting someone who has been taking care of you. But it is my life. If they make a mistake I am impacted or I die."

Gail Ulager, a 72-year-old kidney transplant recipient at UPMC, says she worries about the possibility of infection because she is taking drugs that suppress her immune system to prevent rejection of her new organ. She found a way to give the message to doctors, nurses and even her dentist without seeming disrespectful. "I always tell them that the transplant center insists that everyone washes their hands" she says.

As ridiculous as this sounds, despite millions spent on special antibiotics, this of all things, appears to be the giant advance we have been waiting for.

****Pills made from poop cure serious gut infections

Dr. Thomas Louie, an infectious disease specialist at the University of Calgary, holds a container of stool pills in triple-coated gel capsules in his lab in Calgary, Alberta, Canada on Thursday, Sept. 26, 2013. Half a million Americans get Clostridium difficile, or C-diff, infections each year, and about 14,000 die. A very potent and pricey antibiotic can kill C-diff but also destroys good bacteria that live in the gut, leaving it more susceptible to future infections. Recently, studies have shown that fecal transplants - giving infected people stool from a healthy donor - can restore that balance. (AP Photo/The Canadian Press, Jeff McIntosh)

Associated Press MARILYNN MARCHIONE 10 hours ago

Hold your nose and don't spit out your coffee: Doctors have found a way to put healthy people's poop into pills that can cure serious gut infections — a less yucky way to do "fecal transplants." Canadian researchers tried this on 27 patients and cured them all after strong antibiotics failed to help.

It's a gross topic but a serious problem. Half a million Americans get Clostridium difficile, or C-diff, infections each year, and about 14,000 die. The germ causes nausea, cramping and diarrhea so bad it is often disabling. A very potent and pricey antibiotic can kill C-diff but also destroys good bacteria that live in the gut, leaving it more susceptible to future infections.

Recently, studies have shown that fecal transplants — giving infected people stool from a healthy donor — can restore that balance. But they're given through expensive, invasive procedures like colonoscopies or throat tubes. Doctors also have tried giving the stool through enemas but the treatment doesn't always take hold.

There even are YouTube videos on how to do a similar treatment at home via an enema. A study in a medical journal of a small number of these "do-it-yourself" cases suggests the approach is safe and effective.

Dr. Thomas Louie, an infectious disease specialist at the University of Calgary, devised a better way — a one-time treatment custom-made for each patient.

Donor stool, usually from a relative, is processed in the lab to take out food and extract the bacteria and clean it. It is packed into triple-coated gel capsules so they won't dissolve until they reach the intestines.

"There's no stool left — just stool bugs. These people are not eating poop," and there are no smelly burps because the contents aren't released until they're well past the stomach, Louie said.

Days before starting the treatment, patients are given an antibiotic to kill the C-diff. On the morning of the treatment, they have an enema so "the new bacteria coming in have a clean slate," Louie said.

It takes 24 to 34 capsules to fit the bacteria needed for a treatment, and patients down them in one sitting. The pills make their way to the colon and seed it with the normal variety of bacteria.

Louie described 27 patients treated this way on Thursday at IDWeek, an infectious diseases conference in San Francisco. All had suffered at least four C-diff infections and relapses, but none had a recurrence after taking the poop pills.

Margaret Corbin, 69, a retired nurse's aide from Calgary, told of the misery of C-diff.

"It lasted for two years. It was horrible. I thought I was dying. I couldn't eat. Every time I ate anything or drank water I was into the bathroom," she said. "I never went anywhere, I stayed home all the time."

. Thomas Louie, right, an infectious disease specialist at the University of Calgary, administers …

With her daughter as the donor, she took pills made by Louie two years ago, and "I've been perfectly fine since," Corbin said.

Dr. Curtis Donskey of the Cleveland Veterans Affairs Medical Center, who has done fecal transplants through colonoscopies, praised the work.

"The approach that Dr. Louie has is completely novel — no one else has done this," he said. "I am optimistic that this type of preparation will make these procedures much easier for patients and for physicians."

The treatment now must be made fresh for each patient so the pills don't start to dissolve at room temperature, because their water content would break down the gel coating. Minnesota doctors are testing freezing stool, which doesn't kill the bacteria, so it could be stored and shipped anywhere a patient needed it.

"You could have a universal donor in Minnesota provide a transplant for someone in Florida. That's where we're heading," Donskey said.

Other researchers are trying to find which bacteria most help fight off C-diff. Those might be grown in a lab dish and given to patients rather than the whole spectrum of bacteria in stool.

Thomas Louie, an infectious disease specialist at the University of Calgary, prepares vials in t …

The hope is "we could administer that as a probiotic in a pill form," Donskey said.

Louie sees potential for the poop pills for other people with out-of-whack gut bacteria, such as hospitalized patients vulnerable to antibiotic-resistant germs.

"This approach, to me, has wide application in medicine," he said. "So it's not just about C-diff."

"We’re more microbe than mammal. That really wasn’t well understood a decade ago, and so the new DNA techniques are allowing that. And what’s really remarkable is that not since Darwin’s concept of natural selection has something had such a profound impact on our understanding of “self.” In our anthropocentric world, we think we’re the center of it all, but at the end of the day, the microbes are actually pulling the levers on a lot of what’s going on when you consider that at the gene level they outnumber us 150 to 300 to 1. We’re born with genes that mom and dad gave us, and we’re pretty much stuck with those, but the genes in our gut – again, the bacteria are called the microbiota, and when you add their genes in as well, that’s our microbiome. Of course, a biome is just an ecosystem, so we have this inner ecosystem. So, depending on how we treat them, they can make life OK or they can make it problematic, and when they get out of balance, it’s now thought that that may be the root or the cause of a lot of disease. The problem is working out causality versus correlation."

My experience in medical care has brought me to the conclusion that care near the end of life does not have to be akin to an all out war fought to keep a patient alive till their last dying breath. Alternative options such as palliative care or hospice care are ethical, valid, and most importantly humane options for many. The key word is these must remain as OPTIONS that can be chosen, sampled, refused or changed with the knowledge that the decision is never binding. I still am convinced that medical science has as much capacity to reduce costs as well as increase them. Just think how much death and disease will be prevented when we are better at curing a disease like Hepatitis C. How about dementia or obesity? People will live longer and mostly though not always better.

***************Human Exceptionalism

Life and dignity with Wesley J. Smith.

Time to Prevent Elderly From Living Too Long?

By Wesley J. Smith

December 1, 2013 5:03 PM

Bioethicist Founding Father Daniel Callahan has long supported death panel health care rationing based on age. He has now weighed in against spending a lot on research to delay the aging process.

The transhumanists aren’t going to like this! From, “On Dying After Your Time:”

Even if anti-aging research could give us radically longer lives someday, though, should we even be seeking them? Regardless of what science makes possible, or what individual people want, aging is a public issue with social consequences, and these must be thought through. Regardless of what science makes possible, or what individual people want, aging is a public issue with social consequences, and these must be thought through. Consider how dire the cost projections for Medicare already are. In 2010 more than 40 million Americans were over 65. In 2030 there will be slightly more than 72 million, and in 2050 more than 83 million. The Congressional Budget Office has projected a rise of Medicare expenditures to 5.8 percent of gross domestic product in 2038 from 3.5 percent today, a burden often declared unsustainable.

Contrary to the transhumanist eschatology, Callahan doesn’t believe that extending the length of lives will also mean extending their vitality. I tend to agree. But he doesn’t exactly practice what he preaches:

Modern medicine is very good at keeping elderly people with chronic diseases expensively alive. At 83, I’m a good example. I’m on oxygen at night for emphysema, and three years ago I needed a seven-hour emergency heart operation to save my life. Just 10 percent of the population — mainly the elderly — consumes about 80 percent of health care expenditures, primarily on expensive chronic illnesses and end-of-life costs. Historically, the longer lives that medical advances have given us have run exactly parallel to the increase in chronic illness and the explosion in costs. Can we possibly afford to live even longer — much less radically longer?

Callahan could have refused that expensive treatment. I don’t say he should have, but no one forced him to spend all that (presumably) public money on care.

He does ask a valid question, I think, about the wisdom of pouring resources into radical life-extending research (at least public money). However he also seems to assert that the elderly be somehow prevented from living longer (my emphasis):

We may properly hope that scientific advances help ensure, with ever greater reliability, that young people manage to become old people. We are not, however, obliged to help the old become indefinitely older. Indeed, our duty may be just the reverse: to let death have its day.

What does that mean? Some kind of Logan’s Run scenario?

Callahan isn’t that type. But he should have specified what he meant. As I read him, he seems to be proclaiming some kind of a moral duty of the elderly to die.

Or it could mean refusing efficacious medical care to the elderly that the younger would be able to obtain. In less genteel hands than Callahan’s, it could mean something even more insidious.

The legal use of marijuana for both medical use and adult recreational use is on the rise. Here are five facts that might just surprise you about the drug.

Source: Chuck Coker, Flickr.

1. Marijuana could be the best-selling legal drug. Ever.According to ArcView Market Research, the national market for legalized marijuana could hit $10.2 billion in five years. Pfizer's (NYSE: PFE ) Lipitor currently holds the record for prescription drugs at about $13 billion. If ArcView's prediction is correct, it's not hard to see how marijuana could surpass that record in the following year. It's growing from a base of just $1.44 billion this year.

And unlike Pfizer, which saw Lipitor sales crash once generic versions hit the market, there isn't likely to be a cliff that causes sales to drop precipitously, short of having the federal government decide to crack down on state laws. Of course, unlike Lipitor, you can't invest in one company to capture all the revenue.

2. 14 states could join Colorado and Washington legalizing marijuana for recreational useIn fact, that's one of the driving forces behind ArcView's growth prediction. The sentiment has shifted recently; a majority of Americans now favor legalization. If they vote the same way they answer poll questions, it's likely that we'll see many more states where marijuana use is legal in the coming five years.

The driving force for the states is the potential revenue from taxes. They want to get their cut, which they don't get on illegal sales now.

It'll be interesting to watch Colorado and Washington as they try to deal with how to tax what many consider to be a drug to help people -- which are typically not taxed -- compared with a recreational drug, which, like cigarettes and alcohol, are typically highly taxed.

3. The government sends out marijuana cigarettes each month It's part of a study to see if marijuana could help patients with glaucoma. At its peak, there were 30 patients enrolled in the study, which stopped accepting new participants in 1992. Those still enrolled get sent their prescriptions from a special farm on the University of Mississippi campus that provides the drug for medical research.

4. Only 6% of studies on marijuana investigate its potential benefit.According to CNN's Sanjay Gupta, the other 94% investigate its potential harm. The problem, as Gupta points out, is that it's very hard to run clinical trials on marijuana use since it's still illegal at the national level. While the University of Mississippi farm can provide the medication legally for studies, it's apparently not that all that easy to acquire medication from it.

Researchers also have to gain approval from the NIH's National Institute on Drug Abuse, which has a mission "to lead the nation in bringing the power of science to bear on drug abuse and addiction." That's not exactly a ringing endorsement for potential benefits of drugs.

5. The receptor that marijuana activates has been an (unsuccessful) drug targetTetrahydrocannabinol, or THC, one of the active drugs in marijuana, is available as a prescription drug called Marinol, developed by Abbott's drug arm, now called AbbVie (NYSE: ABBV ) , to stimulate appetite and control nausea and vomiting in patients taking chemotherapy. But the drug isn't widely used because it's absorbed by different people at different levels, making it hard to get the right dosage .

Sanofi (NYSE: SNY ) tried to do the opposite and block the receptor, thus controlling appetite. While Sanofi's obesity drug, Acomplia, was fairly good at helping patients shed the pounds, it had psychiatric side effects including depression. The FDA never approved the drug, and Sanofi had to remove it from the market in Europe in 2008.

*************************************My thoughts: On #1 Best selling drug? Who would grow it and sell it?

On #2 Kind of sad that the driving force for legalization is tax revenue. Just another example how everything is money. I guess one could make similar claims for gambling and prostitution where those are also legal. Alcohol and maybe a sugar tax. The latter suddenly could be labeled a vice.

On #3 I didn't know the government was sponsoring studies on use of marijuana for glaucoma. It can lower intra-orbital pressures but my understanding is the affects were too erratic and there are so many better drugs that the use for this is dubious. I met an eye doctor in Florida who got into trouble with the ATF for testing this. He claimed they ruined his life and his wife eventually committed suicide over it. I only know his side of the story. This was about ten years ago. He was in his seventies.

On # 4 Old drugs do make comebacks. Gupta noted that most studies looked at the harms not the benefits. Remember thalidomide? The drug given to pregnant women in Europe that led to horrible birth defects? Just the mere mention of it afterwards gave everyone the shivers. Now it is a beneficial drug used for other diseases.

On # 5 The Sanofi drug did work to help people lose weight but then a suicide was reported and that was that in the US. I don't know what the experience was in Europe since it was approved there and later taken off their market.

I left the comments from some other readers here:

Help us keep this a respectfully Foolish area! This is a place for our readers to discuss, debate, and learn more about the Foolish investing topic you read about above. Help us keep it clean and safe. If you believe a comment is abusive or otherwise violates our Fool's Rules, please report it via the Report this Comment Report this Comment icon found on every comment.

Report this Comment On December 01, 2013, at 5:25 AM, VikingBear wrote:

Legalize everything.

Let the herd cull itself.

Report this Comment On December 01, 2013, at 8:46 PM, Kalamakuaikalani wrote:

Hard to take your article seriously when you title it "5 Jaw-Dropping Facts ....." & then subtitle number 1: 1. Marijuana could be the best-selling legal drug. Ever. ................... It's not a FACT if marijuana COULD BE. It either is or it isn't & THEN, that would be a FACT.

Report this Comment On December 01, 2013, at 8:53 PM, glenns45 wrote:

Controlled Substance Act of 1971 signed by a President who was forced to resign or be prosecuted. The DEA was created to make sure the right people were selling the Drugs and supporting the NWO. The Feds are the ones who bring in the drugs this is on public record do some research.

Report this Comment On December 01, 2013, at 9:23 PM, towolf2 wrote:

When it smacks somebody upside the chops, then you know what is a fact and what isn't. That's 35 years as a pro grower speaking. Say hey to The Duke for me!!

Report this Comment On December 01, 2013, at 9:26 PM, towolf2 wrote:

Which part am I reading? The educated humorous enriching part, or is this the NASCAR Channel. Caught out again.

Report this Comment On December 01, 2013, at 9:53 PM, oldmutt1949 wrote:

3. French Academy of Science using the atomic microscope has shown long term use of marijuana can alter a person DNA ( Science Daily )

4. Total number of people killed in the drug war in Mexico, central and Latin America exceeds the number of U.S. casualties in VIet Nam.

5. A lot of hippies from my generation who smoked this polluted crap are no longer here.

And last but not least their isn't a single study that has confirmed that all the substances in marijuana are safe evident by he emergency rooms a In Denver and other cities kept busy treating kids poisoned by this stuff because their parents are so dumb down they can't provide their children a safe environment.

Report this Comment On December 01, 2013, at 9:59 PM, fixer wrote:

Hemp used to be such a valuable crop that in George Washington's time ,farms we're required to plant a percentage of their fields with hemp.The oil from the seeds was a good lamp oil and the fiber made strong cloth and rope.

Report this Comment On December 01, 2013, at 10:21 PM, southernhippy wrote:

Old mutt is lying his butt off, Just look at old willie Nelson to see the truth, Pot smoking does not affect your age. Off course old mutt is talking about smoking and not one work about eating.

Report this Comment On December 01, 2013, at 10:24 PM, junior wrote:

something else you forgot oldmutt1949, there was talk about leagalizing it in my state. Even if it does become legalized, we were told by the plant manager that if our random pee test revealed any THC we would still loose our job.

This is why I agree with Vikingbear. Let the herd cull itself. The job market may open up so that someday I can find a job where I can afford a pack of store bought cigarrettes

Report this Comment On December 01, 2013, at 10:32 PM, southernhippy wrote:

BTW mutt lets add some other facts to that mix..

Pot smokers tend to be closer to normal weight...

Higher good cholesterol.

Also lets add the fact that smoking pot don't increase you chances of lung or any other cancer. Not to mention and numerous medical uses of MJ among those would be nausea, seizure control, pain management. So when do we decide when the good outweighs the bad? Almost every war on Pot argument has been debunked, when do you see anything other than hate?

BTW us hippies are alive and well living a great and healthy life style, after all it was us hippies who came up with the who vegetarian thing long before anyone else, peace out...

Report this Comment On December 01, 2013, at 10:57 PM, imnxtc2001 wrote:

"evident by he emergency rooms a In Denver and other cities kept busy treating kids poisoned by this stuff" Yeah oldmutt, them hospital rooms are just packed with them pot smoking whippersnappers. Too funny! If you have any time between your naps and your shuffleboarding league, you can take a few minutes to look up that marijuana by itself equals the same amount of emergency room visits as OTC sleep medicine. I will give you the benefit of the doubt, that you may have been mistaken for synthetic marijuana which is extremely dangerous.

Report this Comment On December 01, 2013, at 10:57 PM, OldSkewel wrote:

Oldmutt1949 is NOT lying southernhippy. ANYONE with at least 1/2 a brain knows it is NOT natural OR healthy to take smoke of ANY kind into a healthy set of lungs.

What I find truly ironic is the very same people that use to jump all over big time tobacco companies and the dangers of smoking absolutely sound like hypocrites now touting the oh so many benefits of cannabis which EVERYONE knows the most popular form of use is the SMOKING thereof.

As far as the economic impact is concerned, it WOULD make sense to legalize it but that's the ONLY reason and EVEN THEN, the economic benefits would be relatively short term compared to the devastating social and moral impact (especially considering America's children) that would no doubt occur as you just as well can take America's public education school system and pitch it out the window, not that it works that well now but can you imagine what would happen if "chronic" was legalized...?

Report this Comment On December 01, 2013, at 11:08 PM, imnxtc2001 wrote:

Just one more observation while I'm still laughing....I'm not perfect with punctuation or grammar, but someone that doesn't smoke marijuana telling me: "jaw breaking" instead of "jaw dropping"...."their" instead "there"....."he" instead of "the"....."a In" instead of just plain out "in" minus the "a" and capital "I".....Geez, I need to smoke a bowl to even make sense of your comment at all.

Report this Comment On December 01, 2013, at 11:09 PM, southernhippy wrote:

Odds of MJ addiction is the same as gambling, Pot has no chemical addiction. You also have the same chance of becoming a workaholic or any other habit that could be considered a bad or good life choice. Pot has been around for more than 10k years and has not stopped any progression of mankind. BTW CBD's that are found in pot are also anti-cancerous, also naturally lowers blood sugars and even can protect the brain in the event of a heart attack or stroke. BTW we are also talking about Eating the plant, y'all do know it's non-toxic and impossible to overdose on right? Y'all are just looking that that lovely drug free propaganda against a persons right to live as they chose too. BTW one other note, Pot does have 5 natural nero keyways in the brain that can open up nero pathways(hence why there is enhanced sight, smells, and creativity.) Pot is indeed a natural product the human mind knows very well. MJ has been demonized for decades for no real reason other than sobriety, nothing else.

I do agree on one Idea though, kids under 21 should not get access and should be treated like booze and advertising should be the same as tobacco when it comes to kids.

Report this Comment On December 01, 2013, at 11:21 PM, imnxtc2001 wrote:

Old Skewel: Is it natural or healthy to drive a car? But you do it anyways don't you? Your trip to the store tomorrow will produce more pollutants into EVERYBODYS air, than one pot smoker can produce in a year. btw....I don't know if you've been asleep the past 50 years, but kids in school(if they choose to)get pot just as easy now, as they would if it was legal and fell under same laws as tobacco. As far as hash...it is basically the same as marijuana, just made from different parts. And the same studies you got your information that it was addictive, are the same ones that say marijuana is also.

Report this Comment On December 01, 2013, at 11:36 PM, HMull81 wrote:

Let’s get a few things right:

First - the problem with legalizing any previously illegal substance isn’t a morally grounded issue; being that most of these substances are vices are not socially accepted when overly indulged anyway.

Second – look up some history and consider why hemp production was ground to a halt in the first place, I’ll give you a hint……

It wasn’t because pothead hippies were overrunning the world with their outrageous free love and open minded way of living, that didn’t come until the 60s.

It is all economic and taxation that has put at spin on what any generation finds acceptable.

It doesn’t matter if you are for or against the legalization of pot, it matters where it would lead to based off of the revenue gained cause face it, the government has stopped doing for the people a long time ago, and if you are current with what is popular; the Kim and Kanye saga get more press than real issues such as legalizing pot, gun law, government debt, and not to forget my favorite government shut down.

I know that if I quit working when I was a soldier in the U.S. Army there were consequences which usually ended with me in a bad kind of way.

Report this Comment On December 02, 2013, at 12:05 AM, allykat7825 wrote:

This will be the first step in finishing off the Regan inspired War against drugs which has cost so many billions over the years. It put the lotteries to shame when the taxes are added up and make many more people happy. Add cocaine to the list and the cartels are a thing of the past, which should please oldmutt. Oldmutt is probably not as old as I am and despite rumors to the contrary, and what many others might think, I still have my wits about me. .

Report this Comment On December 02, 2013, at 1:03 AM, Sniper2013 wrote:

According to CNN's Sanjay Gupta, the other 94% investigate its potential harm. The problem, as Gupta points out, is that it's very hard to run clinical trials on marijuana use since it's still illegal at the national level. While the University of Mississippi farm can provide the medication legally for studies, it's apparently not that all that easy to acquire medication from it".

If the FDA were to subject ANY drug from Big Pharma to the same skewed testing there wouldn't be a new drug on the market for decades. I'm betting that the drugs 'oldmutt' or 'Old Skewel' take to stay alive would never have passed such rigorous testing, and probably contain more virulent side effects than marijuana ever could.

Step into the 21st century, guys, and realize that it's time to put the idiotic and woefully expensive "war on drugs" to rest. It hasn't, and never will, work.

By the way 'old' fellas.....I'm 64 myself and have been a regular pot user for more than 45 of those years. I'm the picture of good health, thanks to a vegetarian diet, and will probably outlive both of you pot demonizers by a decade, at least. Oh, and 'Old Skewel', hashish IS NOT addictive, it's basically the resin from the marijuana flower and is nothing more than a more potent delivery device for THC. The sum total of what you anti-pot "experts" DON'T know is astounding. Then again, when you rely on anti-pot propaganda for your "facts" you're deliberately being fed a pack of lies designed to keep Big Pharma, the Liquor Lobby, and the 'for profit' prison system in customers for years to come. Try thinking for yourself, for once, and do the research so you'll be armed with REAL facts!

I have favored 'de-criminalization' over legalization, a subtle but important difference.

"On #1 Best selling drug? Who would grow it and sell it?" Anyone with a profit motive.

"On #2 Kind of sad that the driving force for legalization is tax revenue. " Agree

"On #3 I didn't know the government was sponsoring studies on use of marijuana for glaucoma. It can lower intra-orbital pressures but my understanding is the affects were too erratic and there are so many better drugs that the use for this is dubious." I believe they can measure and control dosage much better now. (And it's going up at an alarming rate!)

"Hashish IS NOT addictive, it's basically the resin from the marijuana flower and is nothing more than a more potent delivery device for THC." Addictive and habit-forming are synonyms.

"5 other jaw breaking facts about marijuana.1. It has 424 compounds that turns into over 2000 when lit.2. Those 2000 compounds release numerous poisons including hydrogen cyanide and carbon monoxide."

They now vaporize - heat only to the temp that releases the drug - and not light it. Releases fewer toxins.

"kids under 21 should not get access and should be treated like booze and advertising should be the same as tobacco when it comes to kids." Agree, but good luck with that when it is available everywhere. See my first point, decriminalize it, not endorse it.

As the price of sequencing a person's entire DNA has tumbled from $1 billion a decade ago to a few thousand dollars today, many adults—and their physicians—are turning to genetic tests to better understand and manage their health.

The process, though, can be problematic. Some people who test, like the actress Angelina Jolie, learn information that can have dramatic consequences for their health and insurability—and that of their relatives.

And the testing business itself is still young and experiencing growing pains. Last month the Food and Drug Administration ordered genetic-testing firm 23andMe Inc. to stop marketing its $99 mail-order kit. The agency warned that false results could prompt consumers to undergo unnecessary health procedures. The company halted all ads for the kit and said it would work with regulators to address their concerns.

To better understand some of the issues people should consider before undergoing genetic tests, we spoke with Robert Klitzman, director of Columbia University's master's of bioethics program and the author of "Am I My Genes? Confronting Fate and Family Secrets in the Age of Genetic Testing." Here are edited excerpts from the conversation:

WSJ: Should the average person get tested?

(Robert Klitzman: 'A key question is what you will do with the information.' Amelia Panico)

DR. KLITZMAN: We still haven't found the genes responsible for most cases of common diseases, including Parkinson's and the inherited forms of most cancers. But tests have been developed for about 2,000 relatively rare genetic diseases, including the hereditary neurologic disorder Huntington's disease and the BRCA1 and BRCA2 gene mutations—the former of which Angelina Jolie tested positive for—which raise the odds of getting breast cancer to about 50% from 12%, on average.

When deciding whether to get tested, a key question is what you will do with the information. It probably makes sense to test if you believe you are at risk for one of the 24 or so treatable conditions with very predictive tests among the 2,000 with available tests. Aside from breast cancer, they include a form of hereditary colon cancer called Lynch syndrome, familial medullary thyroid cancer, and hypertrophic cardiomyopathy, which can cause sudden death. The presence of certain other genes can also help in predicting responses to some medicines.

It is important to keep in mind that testing positive for a mutation doesn't always mean that you will get ill. Nor does testing negative always mean you are safe. For example, with Alzheimer's, those who receive a genetic variant from both parents have around a 50% to 60% chance of developing the disease, but these patients account for only about 10% of those who get Alzheimer's.

WSJ: What kind of genetic test should individuals get?

DR. KLITZMAN: You can be tested for the specific disease you and your doctor are concerned about. Many insurers cover those tests.

You could also have your full genome sequenced for about $8,000. Interpreting it costs several thousand dollars more. The price of testing your whole genome will probably soon be around $1,000.

For about $100, some companies test portions of your DNA. But these tests aren't always accurate, in part because people can have mutations elsewhere. Before testing, consult with a genetic counselor.

WSJ: Do people have an obligation to share the results with relatives?

DR. KLITZMAN: Ethically, I think we owe it to people to give them information that can help them, if we can. But before you blurt out the results, ask your relatives if they want to know, and raise the subject before you get tested.

WSJ: Should you confide in your doctor?Enlarge Image

DR. KLITZMAN: Some people who test positive for serious diseases hesitate to tell their doctors, because once the information is in their medical charts, an insurance company can access it. A federal law passed in 2008 prevents insurers from using the results of genetic tests to turn people down for most forms of health insurance. But the law doesn't apply to life, long-term-care or disability insurance.

WSJ: What lies ahead?

DR. KLITZMAN: My guess is that in 10 or 20 years, many of us will have our genomes sequenced, and a lot of us will be getting certain information whether we want it or not. My concern is that, in the future, some of these decisions may not be entirely the patient's.

The American College of Medical Genetics and Genomics recently recommended that patients who have all their genes tested get told the results for 56 genes involved with the 24 treatable, serious genetic conditions. But parents would then be told about genes in their children that might have no effect for decades, if ever. All this is a brave new world.

Ms. Tergesen is a staff reporter for The Wall Street Journal in New York. She can be reached at encore@wsj.com.

The FDA is raising safety concerns about antibacterial soaps, which they say are not more effective at preventing illness than plain soap. Tom Burton reports on Lunch Break. Photo: AP.

WASHINGTON—The Food and Drug Administration is challenging the underpinnings of the antibacterial-soap industry by requiring makers to prove that their ingredients are safe and accomplish more than regular hand soaps in fighting bacteria.

The federal agency Monday proposed a rule requiring makers of antibacterial hand soaps and body washes to demonstrate that their products are safe for long-term daily use and are more effective than plain soap and water in preventing illness and spread of infections.

The federal agency acted Monday after some scientists and consumer groups had become skeptical about the advantages of antibacterial soap and after recent studies suggesting that one ingredient—triclosan—could interfere with human hormone activity.

Janet Woodcock, head of the FDA's drug unit, said the extra scrutiny was merited because people are using antibacterial soaps in everyday settings "where the risk of infection is relatively low."Related

Antibiotics of the Future Q&A: FDA Weighs In on Antibacterial Soaps FDA's statement

Two groups representing makers of soaps and detergents protested the move. "We are perplexed that the agency would suggest there is no evidence that antibacterial soaps are beneficial, as industry has long provided data and information about the safety and efficacy of these products," said a joint statement from the American Cleaning Institute and the Personal Care Products Council.

The latter group, whose members include more than 600 companies, has previously highlighted academic studies that found fewer microbes on hands that were washed with antibacterial soap.

Companies sold $5 billion worth of soap, bath and shower products in the U.S. last year, according to market-research firm Mintel Group, whose data also showed that as many as two-thirds of shoppers in this area look for liquid hand soap that is antibacterial.

A spokeswoman for German conglomerate Henkel AG HEN3.XE -0.60% , which owns the Dial brand, said the company is reviewing the FDA's statements, takes the agency's proposal seriously and will work with the agency to provide consumers with safe and effective products. Colgate-Palmolive Co., which owns the Softsoap brand, didn't respond to requests for comment. The brands also make liquid hand soaps without antibacterial properties.

The directive doesn't affect hand sanitizers that don't need water and generally contain alcohol. In fact, the FDA encourages people to use these if soap and water aren't available.

Criticism of the antibacterial soaps centers around three allegations: They may not fight germs any better than regular soaps; their ingredients may have side effects in humans; and they may promote the rise of resistant bacteria.

Andrea Gore, a University of Texas toxicology professor who has studied antibacterial ingredients, hailed the FDA's action, saying there has been an "exponential increase in evidence" about triclosan and its effect on human hormones.

Likewise, Stuart Levy, a microbiologist at the Tufts University School of Medicine, said, "This has been on the agenda for a number of years, and finally we are hearing from the FDA that they are in line with what was recommended by experts to their advisory board several years ago."

Over the decade from 2000 to 2010, several countries in Europe and elsewhere restricted the use of triclosan in consumer products. Reckitt Benckiser RB.LN -1.23% PLC, a British-based consumer-products company known for making Lysol, said it has been phasing out triclosan in all its U.S. products. Currently, it is producing just one containing triclosan, and a spokesman said none of the company's products in the U.S. will contain the ingredient by the end of 2014.

Antibacterial soaps often are sold over the counter at pharmacies and elsewhere. The FDA previously classified them as "generally regarded as safe and effective." But under the proposed rule issued Monday, it is reversing the burden of proof.

Now, manufacturers will have to turn over to the FDA more data on the safety of the soaps and on their effectiveness if they are to stay on the market labeled as "antibacterial soap."

The agency said the new data will need to include evidence from clinical studies demonstrating the soaps' superiority over simple hand-washing with regular soap and water.

The agency said many soaps labeled "antibacterial" or "antimicrobial" contain ingredients mentioned in the proposed rule, such as triclosan and triclocarban. The FDA said some soaps labeled "deodorant" may also contain such substances. The agency said there is some evidence that the substances carry health risks like bacterial resistance and hormonal effects.

After receiving comment and companies' data, the FDA said it expects to make a final decision by September 2016, either banning certain products or allowing them based on new evidence.

"Antimicrobial ingredients proliferated in consumer soaps and washes without ever having to prove their long-term safety or effectiveness," said Sen. Edward Markey (D., Mass.), who has been trying to remove triclosan from the market.

Not all antibacterial soaps contain triclosan. At a Washington, D.C., drugstore display Monday, several soaps described as antibacterial didn't have the ingredient while two did—Dial and the drugstore's brand.

Christopher, a high school student from Katy, Tex., suffered severe liver damage after using a concentrated green tea extract he bought at a nutrition store as a “fat burning” supplement. The damage was so extensive that he was put on the waiting list for a liver transplant.

“It was terrifying,” he said in an interview. “They kept telling me they had the best surgeons, and they were trying to comfort me. But they were saying that I needed a new liver and that my body could reject it.”

New data suggests that his is not an isolated case. Dietary supplements account for nearly 20 percent of drug-related liver injuries that turn up in hospitals, up from 7 percent a decade ago, according to an analysis by a national network of liver specialists. The research included only the most severe cases of liver damage referred to a representative group of hospitals around the country, and the investigators said they were undercounting the actual number of cases.

While many patients recover once they stop taking the supplements and receive treatment, a few require liver transplants or die because of liver failure. Naïve teenagers are not the only consumers at risk, the researchers said. Many are middle-aged women who turn to dietary supplements that promise to burn fat or speed up weight loss.

“It’s really the Wild West,” said Dr. Herbert L. Bonkovsky, the director of the liver, digestive and metabolic disorders laboratory at Carolinas HealthCare System in Charlotte, N.C. “When people buy these dietary supplements, it’s anybody’s guess as to what they’re getting.”

Though doctors were able to save his liver, Christopher can no longer play sports, spend much time outdoors or exert himself, lest he strain the organ. He must make monthly visits to a doctor to assess his liver function.

Americans spend an estimated $32 billion on dietary supplements every year, attracted by unproven claims that various pills and powders will help them lose weight, build muscle and fight off everything from colds to chronic illnesses. About half of Americans use dietary supplements, and most of them take more than one product at a time.

Dr. Victor Navarro, the chairman of the hepatology division at Einstein Healthcare Network in Philadelphia, said that while liver injuries linked to supplements were alarming, he believed that a majority of supplements were generally safe. Most of the liver injuries tracked by a network of medical officials are caused by prescription drugs used to treat things like cancer, diabetes and heart disease, he said.

But the supplement business is largely unregulated. In recent years, critics of the industry have called for measures that would force companies to prove that their products are safe, genuine and made in accordance with strict manufacturing standards before they reach the market.

But a federal law enacted in 1994, the Dietary Supplement Health and Education Act, prevents the Food and Drug Administration from approving or evaluating most supplements before they are sold. Usually the agency must wait until consumers are harmed before officials can remove products from stores. Because the supplement industry operates on the honor system, studies show, the market has been flooded with products that are adulterated, mislabeled or packaged in dosages that have not been studied for safety.

The new research found that many of the products implicated in liver injuries were bodybuilding supplements spiked with unlisted steroids, and herbal pills and powders promising to increase energy and help consumers lose weight.

“There unfortunately are criminals that feel it’s a business opportunity to spike some products and sell them as dietary supplements,” said Duffy MacKay, a spokesman for the Council for Responsible Nutrition, a supplement industry trade group. “It’s the fringe of the industry, but as you can see, it is affecting some consumers.” More popular supplements like vitamins, minerals, probiotics and fish oil had not been linked to “patterns of adverse effects,” he said.

The F.D.A. estimates that 70 percent of dietary supplement companies are not following basic quality control standards that would help prevent adulteration of their products. Of about 55,000 supplements that are sold in the United States, only 170 — about 0.3 percent — have been studied closely enough to determine their common side effects, said Dr. Paul A. Offit, the chief of infectious diseases at the Children’s Hospital of Philadelphia and an expert on dietary supplements.

“When a product is regulated, you know the benefits and the risks and you can make an informed decision about whether or not to take it,” he said. “With supplements, you don’t have efficacy data and you don’t have safety data, so it’s just a black box.”

Since 2008, the F.D.A. has been taking action against companies whose supplements are found to contain prescription drugs and controlled substances, said Daniel Fabricant, the director of the division of dietary supplement programs in the agency’s Center for Food Safety and Applied Nutrition. For example, the agency recently took steps to remove one “fat burning” product from shelves, OxyElite Pro, that was linked to one death and dozens of cases of hepatitis and liver injury in Hawaii and other states.

The new research, presented last month at a conference in Washington, was produced by the Drug-Induced Liver Injury Network, which was established by the National Institutes of Health to track patients who suffer liver damage from certain drugs and alternative medicines. It includes doctors at eight major hospitals throughout the country.

The investigators looked at 845 patients with severe, drug-induced liver damage who were treated at hospitals in the network from 2004 to 2012. It focused only on cases where the investigators ruled out other causes and blamed a drug or a supplement with a high degree of certainty.

When the network began tracking liver injuries in 2004, supplements accounted for 7 percent of the 115 severe cases. But the percentage has steadily risen, reaching 20 percent of the 313 cases recorded from 2010 to 2012.

Those patients included dozens of young men who were sickened by bodybuilding supplements. The patients all fit a similar profile, said Dr. Navarro, an investigator with the network.

“They become very jaundiced for long periods of time,” he said. “They itch really badly, to the point where they can’t sleep. They lose weight. They lose work. I had one patient who was jaundiced for six months.”

Tests showed that a third of the implicated products contained steroids not listed on their labels.

A second trend emerged when Dr. Navarro and his colleagues studied 85 patients with liver injuries linked to herbal pills and powders. Two-thirds were middle-aged women, on average 48 years old, who often used the supplements to lose weight or increase energy. Nearly a dozen of those patients required liver transplants, and three died.

It was not always clear what the underlying causes of injury were in those cases, in part because patients frequently combined multiple supplements and used products with up to 30 ingredients, said Dr. Bonkovsky, an investigator with the network.

But one product that patients used frequently was green tea extract, which contains catechins, a group of potent antioxidants that reputedly increase metabolism. The extracts are often marketed as fat burners, and catechins are often added to weight-loss products and energy boosters. Most green tea pills are highly concentrated, containing many times the amount of catechins found in a single cup of green tea, Dr. Bonkovsky said. In high doses, catechins can be toxic to the liver, he said, and a small percentage of people appear to be particularly susceptible.

But liver injuries attributed to herbal supplements are more likely to be severe and to result in liver transplants, Dr. Navarro said. And unlike prescription drugs, which are tightly regulated, dietary supplements typically carry no information about side effects. Consumers assume they have been studied and tested, Dr. Bonkovsky said. But that is rarely the case. “There is this belief that if something is natural, then it must be safe and it must be good,” he said.

***What Dr. Samadi fails to say is that only 1 in 36 men actually die of it**** Please see yahoo post response to this article included below. Autopsy studies suggest that 75% of men have microscopic prostate cancer in their gland when they died. Proportionately few will even know much less even die of it. Not to say prostate cancer can be ignored - 25 000 die of it every year in the US. So it is very serious. I don't like this guy promoting a procedure he and probably the institution he works with both making a mint from this touting it as the greatest thing since sliced bread. We see this a lot in the medical field. Conflict of interests are Everywhere. And they are not readily reported as pretended by publications like the New England Journal of Medicine. That is not to say there are not very ethical men and women who ARE doing the best they can for humanity and if they can make money from it that is fine. But I am very skeptical this guy is one of them.

******For Prostate Cancer, Radiation Complications May Outweigh Risks

LiveScience.com By Dr. David Samadi, Lenox Hill Hospital in New York City January 31, 2014 7:36 PM

Dr. David Samadi is the chairman of urology and chief of robotic surgery at Lenox Hill Hospital in New York City and is a board-certified urologist and oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer and prostate cancer. Samadi also specializes in many advanced, minimally invasive treatments for prostate cancer; is one of the few urologic surgeons in the United States trained in oncology, open-, laparoscopic- and robotic-surgery; and was the first surgeon in the nation to successfully perform a robotic surgery redo. He contributed this article to LiveScience's Expert Voices: Op-Ed & Insights.

Radiation for prostate cancer has shown once again that it leads to more complications than surgery. For men with prostate cancer, deciding whether to opt for radiation or surgical removal of the gland can be overwhelming. How does one decide with the risks, such as the unpleasant side-effects of erectile dysfunction and incontinence?

Prostate cancer is the second most common malignancy, second only to skin cancer. Unfortunately, doctors diagnose more than 240,000 men in the United States with the disease every year, which translates into 1 in every 6 men being affected by prostate cancer. A new study published last Thursday in the Lancet Oncology Journal found that "men treated with radiotherapy had fewer minimally invasive urological procedures compared to those who chose surgery." However, over time, "the radiation group had a higher proportion of hospital admissions, rectal or anal procedures, related surgeries and secondary cancers."

Men need to take the time to do their research on how "radiation" really works and what side effects they will have to live with. There are two kinds of radiation, external beam and brachytherapy, which involves radioactive material inside the prostate. We as men have all the control in the world to decide what form of treatment is best for us. Do you just want a quick fix that will sometimes show you upfront results from radiation, but will cause you to suffer from side effects in the long run or would you rather choose robotic prostatectomy with minimal bleeding, 95 percent to 97 percent continence rate, and an overall better quality of life? Put aside the temporary leakage and erectile dysfunction that you may receive from robotic prostatectomy, because a year from your surgery those minimal side effects will dissipate.

The questions I suggest my patients ask themselves are:Do you want to be admitted to the hospital more frequently?Do you want to likely bleed from your bladder or rectum?Do you want to risk a second cancer?

This can be the reality for patients who undergo radiation treatments and how it can decrease your confidence and overall quality of life. In the recent study, radiotherapy complication rates were 2- to 10-times higher than complication rates in men who were treated with robotic prostatectomy. Choosing surgery after radiation makes the surgery more complicated. Radiation destroys the surrounding healthy tissue causing the prostate to be embedded in scar tissue. This makes the surgery more complex than operating on tissue that has not been affected by radiation.

Once the prostate is removed, surgeons like myself monitor the prostate-specific antigen (PSA) levels to ensure that the cancer doesn't come back. If radiotherapy is performed prior to the surgery, the PSA will fluctuate due to radiotherapy and pieces of the prostate that are left behind, confusing that monitoring process.

Following a prostate cancer diagnosis, men are flooded with tons of informationand must try to make sense of the different treatment options — it can make even the most educated patient uncertain. [Prostate Cancer Screening Test May Prevent 17,000 Advanced Cases Yearly]

Do your homework and really look at the outcomes one month to one year to a lifetime from now and ask yourself: "Will I be happy with these results?" As the numbers point to robotic prostatectomy, the decision lies in your hands.*****

___________________________________A very good reply from someone in the same specialty who has no financial conflict of interests very unlike this Fox news guy who for quite sometime now has lost my respect as not much more than a self serving charlatan:

****This is a very self-serving & misleading piece of pro-surgery propaganda. Full disclosure: I'm a retired urologist who practiced 20 years privately and was also a clinical prof. at the local medical school. The first item is that the DaVinci robot is currently under multiple suits over its design and propensity to cause serious injuries at surgery leading to major complications, reoperations, permanent urinary incontinence, permanent impotence (erectile dysfunction), and death. It is true that radiation therapy (XRT) has a higher incidence of 'radiation proctitis' (inflammation & bleeding of & from the rectal blood vessels)... since surgical prostatectomy, done correctly, doesn't affect the rectum, that's not surprising since radiation is less precise; although brachytherapy ('seeds') has a far lower incidence. It is also important to understand that all urologists have a vested interest in treating prostate cancer aggressively since the advent of effective medical treatment for benign enlargement of the prostate ('BPH') has rendered the prior 'bread & butter' operation for it (TURP) infrequent. What Dr. Samadi does by waving the scare statistic of 1 in 6 men getting prostate cancer (ACP) is to try and create a stampede of fearful men seeking any means of not dying of prostate cancer. What Dr. Samadi fails to say is that only 1 in 36 men actually die of it (Google: What are the key statistics about prostate cancer?) and that dying of ACP is more a function of the aggressiveness of the cancer than of its treatment - that is; men with aggressive prostate cancers die of it more often than men with less aggressive tumors regardless of how early it's detected or how it's treated. Lastly, the vast majority of men's prostate cancers are detected within the last decade or two of their lives and, if followed until evidence of local growth is note, and XRT given then (followed by hormonal therapy for those rare progressions after XRT) most can live very comfortably and without complications of treatment until their other disease processes take them away... and in my book, even if there's evidence of active prostate cancer, that's effectively a 'cure'.

Diabetic man eats pizza for decades. He also bikes 30 to 40 miles a day which explains part of it. Years ago there was a study that compared an all you can eat vegetable diet with an all you can eat pizza diet. Those in the former group gained more weight. Why? There is more variety in vegetables than pizza. After a while pizza eaters got sick of eating pizza and wound up eating less calories. Part of the mix of the American obesity epidemic is the variety of foods we have available. Italian one day, donuts the next, Chinese third, Ice cream, Mexican is now rampant and all over the place, Chicken and on and on and on:

erectile dysfunction - hang out with a Brazilian wandering spider. It also has the most toxic spider venom:

****Brazilian Wandering Spider: Bites & Other Facts

By Jessie Szalay,

Brazilian wandering spider, spiders

The Brazilian wandering spider belongs to the genus Phoneutria, which means “murderess” in Greek. And it’s no wonder why — it’s one of the most venomous spiders on earth. Its bite can be deadly to humans, although antivenom makes death unlikely. The Guinness Book of World Records has named it the world’s Most Venomous Spider in multiple years.

There are eight species of Brazilian wandering spiders, which can all be found in Brazil. Some of the species can also be found throughout Latin America, from Costa Rica to Argentina. These powerful arachnids have been known to hitch rides internationally in banana shipments, for which they’ve been given the nickname “banana spider.”

In 2007, scientists discovered that in addition to intense pain and possible medical complications, the bite of a Brazilian wandering spider also deliver a long, painful erection to human males. The venom boosts nitric oxide, a chemical that increases blood flow. There has since been talk of incorporating the venom into drugs for erectile dysfunction.

I have to ask my surgeon friends as usually they get a quick path report back that should have told this trainee it was not the appendix. Or with ina day. Sometimes surgeons now treat appendicitis with antibiotics alone and do not perform surgery. I am not clear which is best in pregnancy.There is risk to many antibiotics and pregnancy too.

Scientists alter fat metabolism in animals to prevent most common type of heart disease

Working with mice and rabbits, Johns Hopkins scientists have found a way to block abnormal cholesterol production, transport and breakdown, successfully preventing the development of atherosclerosis, the main cause of heart attacks and strokes and the number-one cause of death among humans. The condition develops when fat builds inside blood vessels over time and renders them stiff, narrowed and hardened, greatly reducing their ability to feed oxygen-rich blood to the heart muscle and the brain.

In a series of experiments, described April 7 in the journal Circulation, the Johns Hopkins team says it identified and halted the action of a single molecular culprit responsible for a range of biological glitches that affect the body's ability to properly use, transport and purge itself of cholesterol—the fatty substance that accumulates inside vessels and fuels heart disease.

The offender, the researchers say, is a fat-and-sugar molecule called glycosphingolipid, or GSL, which resides in the membranes of all cells, and is mostly known for regulating cell growth. Results of the experiments, the scientists say, reveal that this very same molecule also regulates the way the body handles cholesterol.

The Johns Hopkins team used an existing man-made compound called D-PDMP to block the synthesis of the GSL molecule, and by doing so, prevented the development of heart disease in mice and rabbits fed a high-fat, cholesterol-laden diet. The findings reveal that D-PDMP appears to work by interfering with a constellation of genetic pathways that regulate fat metabolism on multiple fronts—from the way cells derive and absorb cholesterol from food, to the way cholesterol is transported to tissues and organs and is then broken down by the liver and excreted from the body.

"Current cholesterol-lowering medications tackle the problem on a single front—either by blocking cholesterol synthesis or by preventing the body from absorbing too much of it," says lead investigator Subroto Chatterjee, Ph.D., a cardio-metabolic expert at the Johns Hopkins Children's Center. "But atherosclerosis is a multi-factorial problem that requires hitting the abnormal cholesterol cycle at many points. By inhibiting the synthesis of GSL, we believe we have achieved exactly that."

Specifically, the experiments showed that treatment with D-PDMP led to:•a drop in the animals' levels of so-called bad cholesterol or low-density lipoprotein, LDL;•a drop in oxidized LDL, a particularly virulent form of fat that forms when LDL encounters free radicals. Oxidized LDL easily sticks to the walls of blood vessels, where it ignites inflammation, damaging the vessel walls and promoting the growth of fatty plaque;•a surge in good cholesterol or high-density lipoprotein, HDL, known to counteract the effects of LDL by mopping it up; and•a significant drop in triglycerides, another type of plaque-building fat.

The treatment also prevented fatty plaque and calcium deposits from building up inside the animals' vessels. These effects were observed in animals on a daily D-PDMP treatment even though they ate a diet made up of 20 percent triglycerides—the human equivalent of eating a greasy burger for breakfast, lunch and dinner. In addition, the researchers say, D-PDMP appears to precision-target the worst byproducts of aberrant cell growth signaling, such as oxidized LDL and the activity of certain chemicals that fuel vessel inflammation, without altering cell growth itself.

D-PDMP, which is already widely used in basic research to experimentally block and study cell growth and other basic cell functions, is deemed safe in animals, the investigators say. For example, animals in the current study had no side effects even when given D-PDMP doses 10 times higher than the minimum effective dose, the study found. The research team is currently designing a compound drug with D-PDMP, which they soon plan to test in other animals and, eventually, in humans.

Mice used in the experiments were genetically engineered to lack a protein essential in the breakdown of fats and thus were predisposed to atherosclerosis. The researchers fed the animals a high-fat diet over the course of several months, but also gave a third of the animals a low-dose of D-PDMP. They gave a double dose of the same inhibitor to another third and placebo to the rest.

When scientists measured the thickness of the animals' aortas—the body's largest vessel and one that carries blood from the heart to the rest of the body—they found striking differences among the groups. As expected, the aortas of mice that got placebo had grown thicker from the accumulation of fat and calcium deposits inside them. The aortas of mice on low-dose D-PDMP, however, were significantly thinner with little to no obstruction. To the researchers' surprise, Chatterjee says, mice eating high-fat foods and treated with high-dose D-PDMP had nearly pristine arteries free of obstruction, indistinguishable from those of healthy mice.

Next, the researchers measured how well and how fast blood traveled through the animals' blood vessels. Slower blood flow signals clogging of the vessel and is a marker of atherosclerosis. The vessels of mice fed a high-fat diet plus D-PDMP had normal blood flow. Mice receiving a high-fat diet without D-PDMP predictably had compromised blood flow.

When researchers examined cells from the animals' livers—the main site of fat synthesis and breakdown—they noticed marked differences in the expression of several genes that regulate cholesterol metabolism. The activity of these genes is heralded by the levels of enzymes they produce, Chatterjee says. Mice treated with D-PDMP had notably higher levels of two enzymes responsible for maintaining the body's delicate fat homeostasis by regulating the way cells take in and break down cholesterol. Specifically, the scientists say, the inhibitor appeared to stimulate the action and efficacy of a class of protein pumps in the cell responsible for maintaining healthy cholesterol levels by transporting cholesterol in and out of the bloodstream. In addition, mice treated that way had higher levels of lipoprotein lipase, an enzyme responsible for the breakdown of triglycerides. A deficiency in this enzyme causes dangerous buildup of blood triglycerides.

Treatment with a D-PDMP also boosted the activity of an enzyme responsible for purging the body of fats by converting these fats into bile, the fat-dissolving substance secreted by the liver.

In a final set of experiments, researchers compared the effects of treatment with D-PDMP in two groups of healthy rabbits, both fed high-fat diets, with half of them receiving treatment. Rabbits that ate high-fat food alone developed all the classic signs of atherosclerosis—fatty plaque buildup in the arteries and stiff, narrowed blood vessels. Their cholesterol levels shot up 17-fold. By contrast, rabbits treated with D-PDMP never developed atherosclerosis. Their cholesterol levels also remained normal or near-normal.

The World Health Organizations estimates that high cholesterol claims 2.6 million lives worldwide each year. More than 70 million Americans have high cholesterol, according to the U.S. Centers for Disease Control and Prevention. Current cholesterol-lowering drugs, such as statins, do not work in about one-third of people who take them, experts say.

"Saturated fat does not cause heart disease"—or so concluded a big study published in March in the journal Annals of Internal Medicine. How could this be? The very cornerstone of dietary advice for generations has been that the saturated fats in butter, cheese and red meat should be avoided because they clog our arteries. For many diet-conscious Americans, it is simply second nature to opt for chicken over sirloin, canola oil over butter.

The new study's conclusion shouldn't surprise anyone familiar with modern nutritional science, however. The fact is, there has never been solid evidence for the idea that these fats cause disease. We only believe this to be the case because nutrition policy has been derailed over the past half-century by a mixture of personal ambition, bad science, politics and bias.

Our distrust of saturated fat can be traced back to the 1950s, to a man named Ancel Benjamin Keys, a scientist at the University of Minnesota. Dr. Keys was formidably persuasive and, through sheer force of will, rose to the top of the nutrition world—even gracing the cover of Time magazine—for relentlessly championing the idea that saturated fats raise cholesterol and, as a result, cause heart attacks.

This idea fell on receptive ears because, at the time, Americans faced a fast-growing epidemic. Heart disease, a rarity only three decades earlier, had quickly become the nation's No. 1 killer. Even President Dwight D. Eisenhower suffered a heart attack in 1955. Researchers were desperate for answers.

As the director of the largest nutrition study to date, Dr. Keys was in an excellent position to promote his idea. The "Seven Countries" study that he conducted on nearly 13,000 men in the U.S., Japan and Europe ostensibly demonstrated that heart disease wasn't the inevitable result of aging but could be linked to poor nutrition.

Critics have pointed out that Dr. Keys violated several basic scientific norms in his study. For one, he didn't choose countries randomly but instead selected only those likely to prove his beliefs, including Yugoslavia, Finland and Italy. Excluded were France, land of the famously healthy omelet eater, as well as other countries where people consumed a lot of fat yet didn't suffer from high rates of heart disease, such as Switzerland, Sweden and West Germany. The study's star subjects—upon whom much of our current understanding of the Mediterranean diet is based—were peasants from Crete, islanders who tilled their fields well into old age and who appeared to eat very little meat or cheese.

As it turns out, Dr. Keys visited Crete during an unrepresentative period of extreme hardship after World War II. Furthermore, he made the mistake of measuring the islanders' diet partly during Lent, when they were forgoing meat and cheese. Dr. Keys therefore undercounted their consumption of saturated fat. Also, due to problems with the surveys, he ended up relying on data from just a few dozen men—far from the representative sample of 655 that he had initially selected. These flaws weren't revealed until much later, in a 2002 paper by scientists investigating the work on Crete—but by then, the misimpression left by his erroneous data had become international dogma.

In 1961, Dr. Keys sealed saturated fat's fate by landing a position on the nutrition committee of the American Heart Association, whose dietary guidelines are considered the gold standard. Although the committee had originally been skeptical of his hypothesis, it issued, in that year, the country's first-ever guidelines targeting saturated fats. The U.S. Department of Agriculture followed in 1980.

Other studies ensued. A half-dozen large, important trials pitted a diet high in vegetable oil—usually corn or soybean, but not olive oil—against one with more animal fats. But these trials, mainly from the 1970s, also had serious methodological problems. Some didn't control for smoking, for instance, or allowed men to wander in and out of the research group over the course of the experiment. The results were unreliable at best.

But there was no turning back: Too much institutional energy and research money had already been spent trying to prove Dr. Keys's hypothesis. A bias in its favor had grown so strong that the idea just started to seem like common sense. As Harvard nutrition professor Mark Hegsted said in 1977, after successfully persuading the U.S. Senate to recommend Dr. Keys's diet for the entire nation, the question wasn't whether Americans should change their diets, but why not? Important benefits could be expected, he argued. And the risks? "None can be identified," he said.

In fact, even back then, other scientists were warning about the diet's potential unintended consequences. Today, we are dealing with the reality that these have come to pass.

One consequence is that in cutting back on fats, we are now eating a lot more carbohydrates—at least 25% more since the early 1970s. Consumption of saturated fat, meanwhile, has dropped by 11%, according to the best available government data. Translation: Instead of meat, eggs and cheese, we're eating more pasta, grains, fruit and starchy vegetables such as potatoes. Even seemingly healthy low-fat foods, such as yogurt, are stealth carb-delivery systems, since removing the fat often requires the addition of fillers to make up for lost texture—and these are usually carbohydrate-based.

The problem is that carbohydrates break down into glucose, which causes the body to release insulin—a hormone that is fantastically efficient at storing fat. Meanwhile, fructose, the main sugar in fruit, causes the liver to generate triglycerides and other lipids in the blood that are altogether bad news. Excessive carbohydrates lead not only to obesity but also, over time, to Type 2 diabetes and, very likely, heart disease.

The real surprise is that, according to the best science to date, people put themselves at higher risk for these conditions no matter what kind of carbohydrates they eat. Yes, even unrefined carbs. Too much whole-grain oatmeal for breakfast and whole-grain pasta for dinner, with fruit snacks in between, add up to a less healthy diet than one of eggs and bacon, followed by fish. The reality is that fat doesn't make you fat or diabetic. Scientific investigations going back to the 1950s suggest that actually, carbs do.

The second big unintended consequence of our shift away from animal fats is that we're now consuming more vegetable oils. Butter and lard had long been staples of the American pantry until Crisco, introduced in 1911, became the first vegetable-based fat to win wide acceptance in U.S. kitchens. Then came margarines made from vegetable oil and then just plain vegetable oil in bottles.

All of these got a boost from the American Heart Association—which Procter & Gamble, the maker of Crisco oil, coincidentally helped launch as a national organization. In 1948, P&G made the AHA the beneficiary of the popular "Walking Man" radio contest, which the company sponsored. The show raised $1.7 million for the group and transformed it (according to the AHA's official history) from a small, underfunded professional society into the powerhouse that it remains today.

After the AHA advised the public to eat less saturated fat and switch to vegetable oils for a "healthy heart" in 1961, Americans changed their diets. Now these oils represent 7% to 8% of all calories in our diet, up from nearly zero in 1900, the biggest increase in consumption of any type of food over the past century.

This shift seemed like a good idea at the time, but it brought many potential health problems in its wake. In those early clinical trials, people on diets high in vegetable oil were found to suffer higher rates not only of cancer but also of gallstones. And, strikingly, they were more likely to die from violent accidents and suicides. Alarmed by these findings, the National Institutes of Health convened researchers several times in the early 1980s to try to explain these "side effects," but they couldn't. (Experts now speculate that certain psychological problems might be related to changes in brain chemistry caused by diet, such as fatty-acid imbalances or the depletion of cholesterol.)

We've also known since the 1940s that when heated, vegetable oils create oxidation products that, in experiments on animals, lead to cirrhosis of the liver and early death. For these reasons, some midcentury chemists warned against the consumption of these oils, but their concerns were allayed by a chemical fix: Oils could be rendered more stable through a process called hydrogenation, which used a catalyst to turn them from oils into solids.

From the 1950s on, these hardened oils became the backbone of the entire food industry, used in cakes, cookies, chips, breads, frostings, fillings, and frozen and fried food. Unfortunately, hydrogenation also produced trans fats, which since the 1970s have been suspected of interfering with basic cellular functioning and were recently condemned by the Food and Drug Administration for their ability to raise our levels of "bad" LDL cholesterol.

Yet paradoxically, the drive to get rid of trans fats has led some restaurants and food manufacturers to return to using regular liquid oils—with the same long-standing oxidation problems. These dangers are especially acute in restaurant fryers, where the oils are heated to high temperatures over long periods.

The past decade of research on these oxidation products has produced a sizable body of evidence showing their dramatic inflammatory and oxidative effects, which implicates them in heart disease and other illnesses such as Alzheimer's. Other newly discovered potential toxins in vegetable oils, called monochloropropane diols and glycidol esters, are now causing concern among health authorities in Europe.

In short, the track record of vegetable oils is highly worrisome—and not remotely what Americans bargained for when they gave up butter and lard.

Cutting back on saturated fat has had especially harmful consequences for women, who, due to hormonal differences, contract heart disease later in life and in a way that is distinct from men. If anything, high total cholesterol levels in women over 50 were found early on to be associated with longer life. This counterintuitive result was first discovered by the famous Framingham study on heart-disease risk factors in 1971 and has since been confirmed by other research.

Since women under 50 rarely get heart disease, the implication is that women of all ages have been worrying about their cholesterol levels needlessly. Yet the Framingham study's findings on women were omitted from the study's conclusions. And less than a decade later, government health officials pushed their advice about fat and cholesterol on all Americans over age 2—based exclusively on data from middle-aged men.

Sticking to these guidelines has meant ignoring growing evidence that women on diets low in saturated fat actually increase their risk of having a heart attack. The "good" HDL cholesterol drops precipitously for women on this diet (it drops for men too, but less so). The sad irony is that women have been especially rigorous about ramping up on their fruits, vegetables and grains, but they now suffer from higher obesity rates than men, and their death rates from heart disease have reached parity.

Seeing the U.S. population grow sicker and fatter while adhering to official dietary guidelines has put nutrition authorities in an awkward position. Recently, the response of many researchers has been to blame "Big Food" for bombarding Americans with sugar-laden products. No doubt these are bad for us, but it is also fair to say that the food industry has simply been responding to the dietary guidelines issued by the AHA and USDA, which have encouraged high-carbohydrate diets and until quite recently said next to nothing about the need to limit sugar.

Indeed, up until 1999, the AHA was still advising Americans to reach for "soft drinks," and in 2001, the group was still recommending snacks of "gum-drops" and "hard candies made primarily with sugar" to avoid fatty foods.

Our half-century effort to cut back on the consumption of meat, eggs and whole-fat dairy has a tragic quality. More than a billion dollars have been spent trying to prove Ancel Keys's hypothesis, but evidence of its benefits has never been produced. It is time to put the saturated-fat hypothesis to bed and to move on to test other possible culprits for our nation's health woes.

Ms. Teicholz has been researching dietary fat and disease for nearly a decade. Her book, "The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet," will be published by Simon & Schuster on May 13.

(Reuters) - When Noah Minskoff's mother died of lung cancer in 2007, e-cigarettes were just entering the U.S. market. Minskoff, who had just started medical school in Utah, wondered whether the devices might have saved his mother's life by helping her quit smoking. Later, he sent some samples to his boyhood friend Nathan Terry, a mechanical engineer, and asked for his opinion.

Terry, who was working in Germany for the French industrial firm Areva, took apart the products to see how they were made. What he found disturbed him: at the heart of the devices were heater wires of unknown quality wrapped around bundles of glass fibers and surrounded by steel wool, silicon, plastic, tape and adhesives.

Wires between the heater, circuit board and batteries were connected with lead solder and also housed in tape and plastic. Everything was close to the heat source, meaning consumers were at risk of inhaling fiber and metal particles as well as toxic fumes from hot plastic and lead.

"There were red flags everywhere," Terry said.

Still, he liked the concept and decided to design a version of his own, avoiding the use of fiberglass, plastic and solder and sourcing his materials entirely in the United States. In 2009 he reunited with Minskoff in California and formed a company, Thermo-Essence Technologies, to sell the product.

At $300 a piece, the e-cigarette serves a niche market, albeit one with a loyal following among medical marijuana patients and smokers looking for a high-end e-cigarette. As many as 30,000 have been sold.

But what began as a quest to develop a better e-smoke has broadened into an ambitious effort to design a new medical device: an inhaler that delivers measured doses of nicotine to help people quit smoking. The technology could also eventually be used as an abuse-resistant delivery device for other drugs, including opioid painkillers.

If successful, the inhaler could become the first new smoking-cessation product to emerge from the e-cigarette field and would compete with products such as GlaxoSmithKline Plc's nicotine gum and Pfizer Inc's antismoking drug, Chantix.

A STARTUP WITH BIOTECH FUNDING

To develop the inhaler, Terry formed a second company, Minusa LLC, which is based in Newtown, Connecticut. Minskoff left Thermo-Essence for family reasons and is not involved in Minusa. Terry himself is leaving Thermo-Essence, which is currently being sold, to concentrate on Minusa.

The new company obtained initial funding from Michael Breede, a commercial real-estate-turned-biotech investor whose father suffered from drug and alcohol addiction and who is eager to see an abuse-resistant painkiller device.

"This is in my wheelhouse," he said. "I think we can put a serious dent in this problem."

When Terry developed his e-cigarette he assumed the U.S. Food and Drug Administration would begin regulating the industry, as it has recently done, proposing a ban on sales to people under the age of 18 and requiring companies to register. Later it could impose product standard and quality controls.

Terry wanted to create a product that would pass any FDA inspection. He used a pure metal wire wrapped around a rod made from magnesia-stabilized zirconia, a highly durable ceramic material. Instead of meshes, tape and plastic he used novel porous ceramics and surgical-grade alloys, and instead of soldering parts together he connected them mechanically, fitting components together like Legos to complete the circuits.

He built on that design to create his drug-delivery device, known as Envi, a single-user, tamper-resistant, metered-dose inhaler.

Envi is about the size of a short cigar and comes with a spare in a case the size of a deck of playing cards.

The nicotine or other drug will come in a sealed cartridge that the patient will insert into the inhaler. To activate the device, the user will have to enter a code. The inhaler will be programed to deliver a certain amount of drug and then turn off.

When the device is returned to the case, which is required after each dose to activate it for the next dose, data on the patient's usage will be downloaded and available to be viewed electronically by the prescribing physician.

"It will only let you take your prescription," Terry said. "It will log your usage and transmit it in real time, and make it easier for the doctor to monitor and interact with the patient."

BUILDING A BETTER INHALER

Terry, 37, who grew up on an organic farm in Ohio to "hippy commune" parents and studied mechanical engineering at the University of Idaho, faces multiple challenges.

Inhalers are typically more expensive to develop than pills, and ensuring patients get the right dose is more complicated.

"I can see a lot of barriers, but the idea is certainly interesting," said Dr. Ben Forbes, a Reader in Pharmaceutics, broadly the equivalent of a U.S. professor, at King's College London who specializes in inhaled medications.

There needs to be a good reason to target a drug to the lungs, Forbes said. Drugs that are inhaled may work faster than pills, so a device that offered quick pain relief in an abuse-resistant form would be "brilliant" if it could be produced economically, he added.

"Changes in inhaler technology have been very incremental over the years, so maybe something like this would have a place."

In the meantime, big tobacco companies are developing alternative nicotine products they hope one day will carry a "modified risk" of harm. Some are dispensed through an inhaler.

Unlike Terry's smoking-cessation device, which he plans to file with the FDA's drug division, these products would be marketed as less risky alternatives to smoking and be processed through the FDA's tobacco division.

However smokers end up using the new products will be the subject of intense research by the FDA.

Terry believes he is creating a product that will survive any market configuration. Minusa has a long way to go, and human trials may be two years off. Eventually he hopes to partner with a big drug company.

"I think we can change how drugs are delivered."

(Reporting by Toni Clarke in Washington; Editing by Michele Gershberg and Prudence Crowther)

I frankly am not sure what to make of this except that I am thinking of going out and buying a plate of (without the bread) corn beef, roast beef, and pastrami, and yes tongue!

In general I suggest to patients just to keep the calories down as much as possible. Diets, low fat, low carb, low this low that. Just low calories with some obvious healthy foods with fiber and nutrients like fruits and vegetables.

I included some of the comments posted in response to the article.

******Heart Association’s Junk Science Diet

By Barbara H. Roberts, MD 4 hours ago The Daily Beast

Heart Association’s Junk Science Diet

The dogma that saturated fat causes heart disease is crumbling.

A recent Cambridge University analysis of 76 studies involving more than 650,000 people concluded, “The current evidence does not clearly support guidelines that [recommend]… low consumption of total saturated fats.”

Yet the American Heart Association (AHA), in its most recent dietary guidelines, held fast to the idea that we must all eat low fat diets for optimal heart health. It’s a stance that—at the very best—is controversial, and at worst is dead wrong. As a practicing cardiologist for more than three decades, I agree with the latter—it’s dead wrong.

Why does the AHA cling to recommendations that fly in the face of scientific evidence?

What I discovered was both eye opening and disturbing. The AHA not only ignored all the other risk factors for heart disease, but it appointed someone with ties to Big Food and bizarre scientific beliefs to lead the guideline-writing panel—just the type of thing that undermines the public’s confidence in the medical community.

The AHA guidelines warrant that saturated fat make up no more than 5 to 6 percent of daily calories for adults because this will lower “bad” (LDL) cholesterol. And, for those people who need blood pressure control, the guidelines also suggest lowering sodium (salt) intake to no more than a teaspoon (2,300 mg) daily.

Despite many other known risk factors for heart disease, salt and fat were, astonishingly, the only two considered by the AHA panel writing the guidelines. There are many other recognized risk factors the AHA ignored, including blood sugar level, low “good” (HDL) cholesterol, insulin levels, and body weight—all of these are influenced by diet.

In fact, most people who have heart attacks don’t have elevations in bad cholesterol. They are much more likely to have metabolic syndrome—a condition that puts you at high risk for diabetes and heart disease. Metabolic syndrome is defined when you have three of the following: high triglycerides (blood fats), high blood sugar, high blood pressure, low “good” cholesterol (HDL-C), and a large abdomen measurement (abdominal obesity).

Interestingly enough, blood triglycerides do not go up with eating fat—they go up if you eat a diet high in processed grains, starches, and sugar. Unfortunately for the proponents of high carbohydrate diets, high blood triglycerides are a major risk factor for heart disease. In addition, low fat/high carb diets lower protective “good” cholesterol and raise insulin. These diets are implicated in the development of diabetes, which is a potent risk factor for developing heart disease.

The writers of the 2013 statin guidelines based their recommendations on studies that looked at the reduction in the risk of events like heart attacks in people treated with statins, compared to people on placebo. The AHA dietary guidelines do not cite any diet studies that looked at whether following a specific diet lowered the risk of developing cardiac events—yet they are giving dietary advice. Why?

There might be two plausible reasons. One is the AHA’s moneymaking “Heart Check Program.” The second is the conflict of interest (and curious beliefs) of Robert Eckel—the co-chair of the panel that wrote the guidelines.

The AHA introduced the Heart Check Program in 1995 and it has been quite the moneymaker, as the AHA sells the Heart Check stamp-of-approval to food manufacturers. Food companies shell out between $1,000 and $7,500 to be certified by the Heart Check Program—and then there are yearly renewal fees. The program currently endorses 889 foods as “heart-healthy.”

And the Heart Check Program is not the only way the AHA benefits from Big Food companies. In their annual report for 2012-2013, the AHA lists among its lifetime donors of $1 million or more Conagra, Quaker Oats, and Campbell Soups, among others.

Forty-five percent of these “heart healthy” foods—over 400 of them—are meat; 92 are processed meats—which have been shown to have either neutral or negative effects on heart health.

Even more problematic are the foods containing added sugar. The AHA recommends that women consume less than 6 teaspoons (100 calories) of sugar a day and less than 9 teaspoons (150 calories) for men. Yet there are items that get the nod of approval from the Heart Check program despite being near or at the sugar limit, like Bruce’s Yams Candied Sweet Potatoes and Healthy Choice Salisbury Steak. Indeed, until 2010, the Heart Check imprimatur was stamped on a drink called Chocolate Moose Attack, which contained more sugar per ounce than regular Pepsi.

And until this year, Heart Check approved many foods with trans-fats, which raise bad cholesterol and lower good cholesterol, among other deleterious effects on health, like increasing inflammation and the laying down of calcium in arteries.

Like the dietary guidelines, the AHA Heart Check Program appears to address only the effect of foods on cholesterol level and blood pressure. Meanwhile, since the 1970s, our yearly sugar consumption has skyrocketed along with the incidence of diabetes and obesity.

This brings us to Dr. Robert H. Eckel, the co-chair of the Working Group. He is a consultant for Foodminds, which specializes “in food, beverage, nutrition, health and wellness.” Foodminds works with more than 30 leading food, beverage, and nutrition to offer a “one stop shop of…consulting…to guide food and beverage companies in navigating the complexities around the upcoming FDA Nutrition Facts label overhaul.” In other words, Foodminds is a lobbying firm for “Big Food.”

And then there is this:

Dr. Eckel describes himself as “a scientist and professing six-day creationist and a member of the technical advisory board of the Institute for Creation Research…” Many scientists are religious. This is not to question Dr. Eckel’s religious beliefs, but to question his ability to think scientifically. He believes there is scientific proof that the world was created in six days and that evolution does not exist. This should at least raise eyebrows when the co-chair of an influential panel charged with giving scientifically sound dietary advice has a financial conflict of interest and proselytizes for beliefs that are anti-scientific.

Practice guidelines affect both public policy and medical practice. We should expect professional medical organizations —like the American Heart Association—to examine all the evidence relating to diet and heart disease risk.

The American people should be able to trust that only impartial scientists write guidelines. We should be confident that those experts are not working to advance corporate interests and that they do not espouse beliefs that are well outside the scientific mainstream. An avowed creationist who consults for a food lobby hardly seems an appropriate choice to fulfill these criteria.

READ MORE The Truth About Salt

For the last several decades, the AHA has promoted a low fat high carbohydrate diet as a cornerstone of heart health. It has taken a very public position that saturated fats are a major driver of heart disease risk and the mounting tide of evidence that this is dead wrong must put them it in a very uncomfortable position. And yet a fundamental requirement of science—as opposed to propaganda—is that when evidence that contradicts a hypothesis is replicated over and over again, that hypothesis must be abandoned.

The idea that eating high amounts of saturated fat causes hardening of the arteries—the so-called “diet-heart hypothesis”— deserves to be jettisoned along with other discredited belief systems. Creationism comes to mind. Will the AHA step up to the plate?

The American Heart Association had not returned an inquiry for comment at the time of publishing.

...

.10 Comments .

Ernesto 1 hour ago

two years ago, I realized that the AHA did NOT need my donation. It seemed to me that most of their donations may come from the food and pharmaceutical industry so, they really don't need either my participation on the heart day walk. Their statistics show that during the past 30 years their guidelines and recommendations are linked to a double fold increase of heart disease in the U.S. And the sad part is that doctors, specifically cardiologists, and health insurances either promote or follow these inept guidelines. Recently, I almost purchase a food brand deli turkey which it showed a heart check on the label. I decided to read the ingredients to find out that the processed meat contained too much sodium and phosphates. Both ingredients are bad for the heart. AFP RELAXNEWS Wednesday, May 7, 2014, 10:39 AM Phosphates, which are also found in Parmesan, colas and baking soda, may stimulate the production of the hormone FGF23, which puts a strain on the heart and can lead to high blood pressure and cardiovascular disease, researchers said.....

Definitely, the AHA doesn't need my two cents... I don't need their two cents either.

oh well 55 minutes ago

Dr. is correct as she is wrong in her approach. Levels of cholesterol and other lipids are a result for most people higher than normal weight values and excessive intake of fats and sugars. High blood pressures can be influenced by amount of salt intake, however salt in itself is not the only culprit: kidney disease, stress and release of catecholamines contribute to arterial injury as does smoking: the latter being a virtual do not enter area for heart patients and their families. Exercise to help control weight, increase HDL and help in lowering levels of glucose and stress hormones all contribute to a healthier person who feels better and sees the world in a better light which influences attitude and heart health and brain health as well..

In essence balance is a key for most people but be careful of those heavy meals and overdoing it whether at the gym or the table.....

Have a nice day.

Sandra 2 hours ago

I did a research paper for school a couple of years ago that validates what this article is saying about saturated fats. Not sure why the author finds it necessary to back up her view by bringing Dr. Eckel's belief in creationism as some kind of evidence to back up the idea? There is enough material available on diet and heart disease to prove the point. I don't believe in the 6 day creationism story either, but don't see how it can discount someone as a scientist.

MrHersch11 49 minutes ago

I was rolling right along, agreeing with each of Dr Roberts' points, and then she throws in the creationism thing. That's a whole separate issue, and her use of that issue tends to make you forget all the valid points she made throughout the rest of the article. She'd have been better off making her points about AHA and diet, and then shutting up.

Sam 51 minutes ago

Being stupid is relevant.

Seldom Wrong 20 minutes ago

Sugar and grain based foods do far more damage than meat and dairy. After 60 years of pushing an unhealthy diet, the American Heart Association has succeeded in making us all fat and sick. When are they going to own up to their guilt and change their recommendations? If they keep pushing the same lies, they don't deserve anyone's support.

Candy 1 hour ago

So is this article attacking the diet that the AHA backs up or is it attacking creationism and Dr. Eckel?

Lothar F 39 minutes ago

The AHA, and the AMA as well, have sold us, the public, down the river to big business interests. People need to use common sense and stick to a traditional diet that does not contain any processed or refined foods.

Sam 44 minutes ago

How does a nutball end up in any scientific position?

My clinic recommends one third fat for most diets.

JohnW 1 hour ago

I'm so glad this is finally coming out. Dr. Atkins said this for years. People's health would greatly benefit it they would cut out the cookies and pop.

Lynne 2 hours ago

If true, this is all fairly damning. Shame on the AHA for allowing it.

I have stuff like the Bodymedia device and I pitched in on another device by Push Strength.

« Last Edit: June 01, 2014, 12:01:38 AM by Dog Robertlk808 »

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"You see, it's not the blood you spill that gets you what you want, it's the blood you share. Your family, your friendships, your community, these are the most valuable things a man can have." Before Dishonor - Hatebreed

I agree Guro, but with all this data sometimes it seems like you will need help interpreting it to make it useful, some of the info is obvious and then since all this data has the ability of being stored in the cloud here come the security issues.

Which takes us to another thread of Cyber Security. Now that I am working for a hospital in the InfoSec field I have become more aware of things that I just never thought of. I read a few articles where your health information is more valuable than just your credit card. Your health records never really expire and they contain a lot of data about you including your payment methods.

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"You see, it's not the blood you spill that gets you what you want, it's the blood you share. Your family, your friendships, your community, these are the most valuable things a man can have." Before Dishonor - Hatebreed

What did I do?I explored how diet changes influenced my level of free testosterone. In addition, I observed how changes in testosterone related to my mood, sleep and energy level.

How did I do it?Over the course of one year, I regularly checked my level of free (active) testosterone in saliva and correlated the results to other data I had collected using apps and tracking devices.

What did I learn?I learned that eliminating carbs from my diet resulted in lower testosterone and adding carbs together with fat and protein increased testosterone. I also learned that sleep was closely tied to my level of testosterone. After good nights of sleep (usually more than 8 hours), my level was elevated the next morning.

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"You see, it's not the blood you spill that gets you what you want, it's the blood you share. Your family, your friendships, your community, these are the most valuable things a man can have." Before Dishonor - Hatebreed

Probably all or at least the vast majority of these marketing natural health substances are scams. They all pretty much follow the same format. Some con artist picks up on some lousy or worthless study published in some journal and then turns around to sell some product that will make one feel younger, cure or ease joint pain, help one sleep better, or have the sexual drive of a 14 yo, live longer, feel more energetic, reduce fatigue depression anxiety and all the rest.

The site how they are the only ones who get it pure, or in the correct mixture, or from some rare plant in S America. They try to impress with their PhD or memorizations of some biochemical pathways. I truly suspect some of the University people who actually do these studies are in on the scams. Many are most certainly receiving some kickbacks. Oz maybe doesn't but I am sure some of these people who do studies do.

I am glad we are seeing more public outrage of this. As for Dr. Oz I really know little about him and have never listened to him though a few people have asked me about some things he has said.

****WASHINGTON (AP) — Under pressure from Congress, celebrity doctor Mehmet Oz on Tuesday offered to help "drain the swamp" of unscrupulous marketers using his name to peddle so-called miracle pills and cure-alls to millions of Americans desperate to lose weight.

Oz appeared before the Senate's consumer protection panel and was scolded by Chairman Claire McCaskill, D-Mo., for claims he made about weight-loss aids on his TV show, "The Dr. Oz Show."

Oz, a cardiothoracic surgeon, acknowledged that his language about green coffee and other supplements has been "flowery" and promised to publish a list of specific products he thinks can help America shed pounds and get healthy — beyond eating less and moving more. On his show, he never endorsed specific companies or brands but more generally praised some health supplements as fat busters.

McCaskill took Oz to task for a 2012 show in which he proclaimed that green coffee bean extract was a "magic weight loss cure for every body type."

"I get that you do a lot of good on your show," McCaskill told Oz, but "I don't get why you need to say this stuff because you know it's not true."

Oz insisted he believes in the supplements he talks about on his show as short-term crutches and even has his family try them. He said his job on the show is to be a "cheerleader" for his audience, one who offers hope even if that means looking to alternative healing traditions and any evidence that might support them.

But Oz did agree that there's no long-term miracle pill out there without diet and exercise.

Within weeks of Oz's comments about green coffee — which refers to the unroasted seeds or beans of coffee — a Florida-based operation began marketing a dietary supplement called Pure Green Coffee, with claims that the chlorogenic acid found in the beans could help people lose 17 pounds and cut body fat by 16 percent in 22 weeks.

The company, according to federal regulators, featured footage from "The Dr. Oz Show" to sell its supplement. Oz has no association with the company and received no money from sales.

Last month, the Federal Trade Commission sued the sellers behind Pure Green Coffee and accused them of making bogus claims and deceiving consumers.

The weight-loss industry is an area where consumers are particularly vulnerable to fraud, Mary Koelbel Engle, an associate director at the FTC, testified at the Senate hearing. She said the agency conducted a consumer survey in 2011 and found that more consumers were victims of fraudulent weight-loss products than of any of the other specific frauds covered in the survey.

Oz stressed during the hearing that he has never endorsed specific health supplements or received money from the sale of supplements. Nor has he allowed his image to be used in ads for supplements, he said.

"If you see my name, face or show in any type of ad, email or other circumstance," Oz testified, "it's illegal" — and not anything he has endorsed. He hasn't allowed his name to be associated with specific brands, he said, because of ethical concerns he has about doctors making endorsements of health products.

Sen. Richard Blumenthal, D-Conn., asked Oz if he would be willing to create a master list of brands he feels work, instead of suggesting that a general supplement may work for weight loss and then leaving consumers to poke around on the Internet in hopes of finding something.

"I've been actively looking at that," said Oz. "With your suggestion and support, I think I'm going to do it and I think it'll do a lot to drain the swamp that we've created around this area."

Copyright 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.****

In a ruling that could upend President Obama’s health care law, a federal appeals court ruled Tuesday that the government could not subsidize premiums for people in three dozen states that use the federal insurance exchange. The 2-to-1 ruling could cut off financial assistance for more than 4.5 million people who were found eligible for subsidized insurance in the federal exchange, or marketplace.

Under the Affordable Care Act, the court said, subsidies are available only to people who obtained insurance through exchanges established by states.The law “does not authorize the Internal Revenue Service to provide tax credits for insurance purchased on federal exchanges,” said the ruling, by a three-judge panel of the United States Court of Appeals for the District of Columbia Circuit. The law, it said, “plainly makes subsidies available only on exchanges established by states.”

I've heard this is the most expensive hospital in the country. One of the guys who bought the hospital at basement rates, who used to be with Blackstone got his Wall Street buddies to finance fixing the place up and embarked on an out of network strategy and then resold it for something like a 40 million profit. The health care mogul as he was called in a news article now has a mansion in the Hamptons. So this poor guy gets stuck with a 9K bill.

I have a patient who told me he went to this hospital which is much farther from here than several others to have a procedure done via a limousine. In this way the patient got in his mind "first class treatment". The bill is usually multiples of what it would otherwise cost. I explained this abuse to the patient. His response: "but it didn't cost me anything". I asked him doesn't this dishonest game playing while using you as the pawn bother you? His response, was again "it didn't cost me a thing".

So there you have it. I replied, but it costs everyone else a bundle to finance this. What do you think happens to everyone's insurance rates with this going on? No response from him. No concern.

*********Hospital ER Charges $9,000 to Bandage Cut Finger

Money Talks News By Krystal Steinmetz 8 hours ago

A New Jersey teacher was stunned when he received a $9,000 bill after his cut finger was bandaged in a hospital emergency room. Baer Hanusz-Rajkowski cut his finger with the claw end of a hammer. After waiting a few days to see if it would heal on its own, Hanusz-Rajkowski decided to go to the emergency room at Bayonne Medical Center in New Jersey, according to NBC New York. It was determined (without X-rays) that his finger didn’t need stitches. So Hanusz-Rajkowski left with a bandaged middle finger. NBC New York said he was surprised to get this in the mail:

Hanusz-Rajkowski got hit with an $8,200 bill for the emergency room visit. On top of that, Bayonne Medical Center charged $180 for a tetanus shot, $242 for sterile supplies, and $8 for some antibacterial ointment in addition to hundreds of dollars for the services of the nurse practitioner.

That $9,000 bill left Hanusz-Rajkowski speechless. From NBC:

“I got a Band-Aid and a tetanus shot. How could it be $9,000? This is crazy,” Hanusz-Rajkowski said. “If I severed a limb, I’d carry it to the next emergency room in the next city before I go back to this place.”

Why was the bill so high? The answer isn’t clear. It’s more of a he said, she said. Carepoint Health bought Bayonne Medical Center about six years ago, making it a for-profit business, NBC said. Dr. Mark Spektor, president and CEO of the medical center, said the big bill is the fault of Hanusz-Rajkowski’s insurance company, United Healthcare, which no longer has an in-network pricing contract with the hospital. Spektor said United doesn’t offer fair reimbursement rates. According to NBC, Mary McElrath-Jones, spokeswoman for United Healthcare, disagrees with Spektor. “United Healthcare is deeply concerned about hospitals establishing an out-of-network strategy to hike the rate they charge for emergency room services, often surprising patients,” she said. Regardless of whether there’s an in-network price deal, New Jersey law demands that insurers cover the costs of ER visits, NBC said. United Healthcare ended up paying $6,640 on the bill. After the story hit the news, the hospital wrote off Hanusz-Rajkowski’s portion of the bill. Some people are calling for a price cap on ER procedures, NBC reported. Spektor said that would put the hospital, which was once on the brink of bankruptcy and is now profitable again, at risk.

“Insurance companies in the state of New Jersey particularly have had record profits last year. Billions of dollars in profits while hospitals are struggling and closing. That is the real story,” Spektor said.

What do you think of Hanusz-Rajkowski’s hospital bill? Do you think you’ve been massively overcharged at a hospital? Share your comments below or on our Facebook page.

This article was originally published on MoneyTalksNews.com as 'Hospital ER Charges $9,000 to Bandage Cut Finger'.

In a sign that price competition may take hold for hepatitis C drugs, the nation’s largest manager of prescriptions will require all patients to use AbbVie’s newly approved treatment rather than two widely used medicines from its rival Gilead Sciences.

The pharmacy benefit manager, Express Scripts, said it had negotiated a significant discount from AbbVie in exchange for making the drugmaker’s treatment, Viekira Pak, the exclusive option for 25 million people. Express Scripts also said it would allow all people with hepatitis C to be treated with AbbVie’s drug, not only those with more serious liver damage.

“We really believe we want all patients treated,” Dr. Steve Miller, the chief medical officer of Express Scripts, said in an interview Sunday. He said that AbbVie had made that affordable by offering “a significant discount.”Continue reading the main storyRelated Coverage

Gilead’s drugs have set a new standard, curing the vast majority of patients in only 12 weeks with few side effects. But their prices have ignited an outcry. One drug, Sovaldi, has a list price of $84,000 for a typical 12-week course of therapy, or $1,000 per daily pill. The newer Harvoni costs $94,500 for 12 weeks.

Gilead says the prices reflect the value the drugs bring to patients and the health care system. But some health plans, state Medicaid programs and prison systems say the drugs are busting their budgets. Many have been limiting treatment to only the sickest patients. Congress has investigated the prices, and Philadelphia’s transit authority sued Gilead this month, saying its “price-gouging” violated antitrust laws.

Express Scripts has been one of the loudest complainers, with Dr. Miller even calling himself the “chief whining officer.” He has threatened to boycott Gilead’s drugs once alternatives were available and now seems to be doing just that.

Initial hopes that AbbVie would compete on price seemed to be dashed Friday, when Viekira Pak won approval from the Food and Drug Administration. AbbVie set the price at $83,319 for the typical 12-week course, not a huge discount to Harvoni.

But list prices are not the entire story. Health plans and pharmacy benefit managers negotiate discounts in exchange for a better positioning on the formulary, the list of approved drugs. Express Scripts’ announcement suggests AbbVie is being more aggressive behind the scenes than it is with its list price.

The discounts will help hold down health care costs for employers that use Express Scripts but patients will probably not notice an immediate cost difference, such as lower co-payments.

Preferred position on the formulary typically means the preferred drug must be tried first, or has a lower co-payment.

But recently pharmacy benefit managers have been trying a more powerful weapon to increase their bargaining leverage — refusing to pay at all for the less preferred drug. Express Scripts’ national preferred formulary, which is used by many employers and covers 25 million people, will exclude about 70 drugs next year, including Harvoni, Sovaldi and another new hepatitis C drug, Johnson & Johnson’s Olysio.Continue reading the main story Continue reading the main storyContinue reading the main story

Gilead, in a statement, said it had “been negotiating in good faith with Express Scripts and other payers” and hoped to continue to have discussions “that focus on the best interests of patients with hepatitis C.” A company spokeswoman declined to say what fraction of Gilead’s hepatitis C sales were covered by Express Scripts.

Doctors who treat hepatitis C cheered the fact that all patients would be treated, regardless of the severity of their disease.

“It’s going to expedite treatment for patients,” said Dr. Rena Fox, a hepatitis specialist at the University of California, San Francisco. “It certainly avoids putting doctors in a very uncomfortable position of having to say yes to some patients and no to other patients.” Dr. Fox said that any differences between AbbVie’s and Gilead’s drugs were minor, so there was no problem in excluding Gilead’s drugs.

But Dr. Eugene Schiff, director of the center for liver diseases at the University of Miami, disagreed. He said Harvoni was one pill once a day while AbbVie’s drug required four pills, three in the morning and one in the afternoon. And many patients getting Viekira also have to take ribavirin, an older drug that can have serious side effects.

“To say that it’s exclusively this drug is not right,” Dr. Schiff said.

Harvoni and Viekira Pak are approved only for so-called genotype 1 hepatitis C, which accounts for about 70 percent of cases in the United States. Express Scripts said it would still pay for Sovaldi when used to treat other genotypes. And patients already taking Sovaldi or Harvoni can continue.

Dr. Miller would not disclose the discounts AbbVie is providing but said it would significantly narrow the gap between prices charged in the United States and Western Europe. Sovaldi has been selling for $50,000 to $70,000 in some European countries.

AbbVie also agreed not to charge twice as much when patients needed to take 24 weeks of Viekira Pak instead of 12. And Express Scripts will distribute the drug exclusively through its own specialty pharmacy, so it will make money on distribution.

In addition to giving AbbVie exclusivity and agreeing to treat all patients, Express Scripts also said it would allow doctors other than liver specialists and infectious disease specialists to prescribe Viekira, further widening the market.

Gilead Sciences struck back on Monday against its rival AbbVie in a budding marketing war over costly hepatitis C drugs, winning exclusive access to many patients whose prescriptions are managed by CVS Health.

CVS Health, the nation’s second-largest pharmacy benefits manager, said that it would make Gilead’s drugs, Harvoni and Sovaldi, the exclusive option for patients on its commercial drug list, as well as for patients it manages on health care exchanges, Medicare Part D and Medicaid.

The decision partly counteracts a decision made last month by Express Scripts, the largest pharmacy benefit manager, to make AbbVie’s Viekira Pak the exclusive option for most patients in its main commercial plan covering 25 million people.

AbbVie earned that position by offering what Express Scripts characterized as a significant discount below Viekira’s list price of $83,319 for a typical 12-week course of treatment.

Express Scripts’ move caused a steep drop in Gilead’s shares and in many other biotech stocks because it suggested that pharmacy benefit managers were becoming more willing to limit patient options to procure discounts from drug companies, limiting the ability of drug manufacturers to charge high prices.

Geoffrey C. Porges, biotechnology analyst at Sanford C. Bernstein & Company, said that once Gilead was excluded by Express Scripts, it had a strong incentive to strike a deal with CVS “in order to ensure a reasonable level of access and also to avoid overblown negative perceptions of poor access.”

Gilead ignited protests by pricing Sovaldi, its first drug for hepatitis C, at $84,000 for a 12-week course of treatment, or $1,000 per daily pill. Gilead’s newer Harvoni has a list price of $94,500 for the 12 weeks of treatment, or $1,125 per daily pill.

While doctors have hailed both drugs as breakthroughs, some health plans, state Medicaid programs and prison systems said they could not afford to treat everyone at those prices. More than three million people in the United States are infected with the hepatitis C virus, which gradually destroys the liver.

The hope was that when AbbVie won approval for Viekira Pak in December, competition would drive down prices. That appears to be happening, though to what extent is not known because pharmacy benefit managers do not reveal how much of a discount they are getting.

CVS said in a statement that it goal “was to create the lowest net-cost solution for the entire population of patients” with hepatitis C. CVS’s decision was first reported by The Wall Street Journal.